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SITE ADDRESS <br />�� <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />. _ -%{/�`� <br />/[�� <br />TENANTNAME <br />�r,�ly <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDIN( <br />� �) <br />WORK S RIPTI <br />��./.� <br />� <br />. - <br />P�RiVIIT APPLICATI�N <br />C1TY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />S ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />BLOCK TRACT � <br />/ ADDRESS <br />^, � ?, . � <br />�(�o <br />C P1T CT OR PEF <br />, , <br />, ; l , � �, <br />�� ADDRESS <br />'�0118��'1 �0;1� ��r�. <br />CITY2IP <br />�' <br />�` ��,�r�1 l�/�, <br />/ <br />HEATSOURCE <br />Eleclric ,� Gas _ Olher <br />�i!�� /� > �� 2 '� � <br />NO. I TYPE OF FIX7URE OR ITEM <br />Toilet <br />Balhlub <br />Lavatory (v�ash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Waler healer <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinkin� Founlain <br />Floor drain <br />Grease trap <br />f2oof drains <br />Olher <br />RMIT # <br />;��; -23 <br />PHONE <br />CONTRACT PRICE OF WORK <br />2.� ,7/�I4 - <br />NO. I TYPE OF FIXTURE OR ITEM <br />- NC - air handling units <br />Forced air systems <br />—T Gas piping <br />� Waterhealer <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit healer <br />�� Boiler <br />Refrigerelion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TNC CODE IS 3105 <br />I hereby ceritify thal I have read and examined this application and know lhe same to be true and correcL All provisions of laws and <br />ordinaces governing this type o( work will be complied with whelher speci(ied herein cr noL The granting o( a permit does not presume <br />to give aulhority lo violate or ncel the provision of any other state or local law regulating consiruction or the performance of <br />construction. That I am aulho�zed by the owner o( this property to perform the work for which application is made and I comply wilh the <br />Slale Conlractors Law 18.27 CW and 296.200 WAC. <br />��Z <br />