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SITE ADDRESS <br />, - ;.,;>, . <br />� � r 'r v �.��_ <br />L AL� � LOT N0. <br />DES� <br />TENANTNAME <br />� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />PERMIi APPf�iCATION <br />CITY OF EVERETT PERMIT SERVEC€� <br />3200 CEDA�� STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425 257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �, ��� ,� �j�JC� <br />- � -� <br />�, PARCEL TAX I.D. # PERMI�.:,# .� <br />�� , '�/�,� 1'D�/G ���Yib4Z00 �,_ D�v� � E.�� <br />BLOCK TRACT OR SUBDI\'ISION # <br />WORK DESCRIPTION /J-�rG <br />a�=. <br />�y� ��.� �sis � <br />CONTACT FOR PERMIT <br />ADDRESS <br />Cra � /�u� <br />/�✓G <br />HEATSOURCE <br />_ Eleclric �Gas _ Olher <br />��3 <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhtub <br />Lavatory (wash basin) <br />Shuwer <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Wa�er heater <br />Sinh (service/bar/mup/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />f loor drain <br />Grease Irap <br />Roof drains <br />Other <br />CITYIZIP PHONE y'S" <br />�_1i�'�-/U . �%J �?�'G <br />PHONE <br />E•MAII. <br />CITYIZIP �HONE <br />,�f✓rllr Y:2S' <br />�''1�? f0 �6D r'��U <br />CONTRACT PRICE OF WORK <br />l/.f'O�DU <br />NO. I TYPE OF FIXTURE OR ITEM <br />. <br />r � <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas (ireplace <br />Gas ranye <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unit heater <br />Boiler <br />Re(ric�eralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 31J5 <br />I hereby ceriti(y thal I have read and examined lhis application and know the same to be true and correct. All provisions o( laws and <br />ordinaces �overniny this type of work will be complied with whelhcr specilied herein or not. The granling o( a permit does nol presume <br />l0 9ive aulhority to violale or cancel Ihc provision o( any olher state or local la�v regulaling construction or the performance of <br />consiruclion. That I am aulhorized by the owner of this property to perform ihe work (or which application is made and I comply wlth lhe <br />S�ate Cortractors Law 18.27 RCW and 296.200 WAC. <br />_��f�� �� <br />SignaWre o( �vne onlractodAuthorized Agenl Dale �/.,� <br />/ <br />