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SITE ADDRESS <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />7HNln�E � <br />TENANTNAME <br />PtRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR 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 <br />PARCEL TN( I.D, p <br />BLOCK TRACT <br />ADDRESS CITY2IP <br />�20�' <br />2/f •- l�f � Si .T. C FvE/1c'77� w.i . <br />I CONTACT FOR PERMIT <br />CONTRACTOR SM !�� / <br />C�O A.',f'Ti1UC7,� N <br />CONTR. LICENSE N <br />r .b lwn.� <br />USE OF BU <br />WORK DESCRIPTION <br />ADDRESS <br />/o %Z 7- Z� s'r�it, S.C-C_ <br />NO. � TYPE OF FIXTURE OR ITEM <br />Tailal <br />Dalhtub <br />Lavatory (wash basin) <br />Showor <br />Kilchon slnk & disposal <br />Dishwashor <br />Clothes washor <br />Laundry tray <br />Sink (scrvir,o/bar/mopletc.) <br />Backflow provonter <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Groaso lrap <br />Roof drains <br />Othor <br />CIT'RIP <br />PERMIT N <br />___ ��a" <br />PHONE — <br />�5�8Si7v <br />PHONE <br />PHONE (� 2 S - <br />Evc,er� 9S'�8 3�70�65� <br />— HEAT SOURCE I CONTRACT PRICE OF WORK <br />Eloclric _ Gas _ Olher <br />EL <br />NO. I TVPE OF FIXTURE OR ITEM <br />A/C - air hanAling units <br />Forcad alr systems <br />Gas piping <br />Waler healor <br />Gas Oreplace <br />Gas range <br />Clothas dryer <br />Rango hood <br />Exhausl lan <br />Heat pump <br />UMt healor <br />Boilar <br />Rofrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL 9ALES TAX CODE IS 7105 <br />I hereby ceritily thal I havo read and oxamined this appticalion and know the same lo be lrue and conecl. All provislons of laws end <br />ordinacos govoming thls typo ot work will bo complied wllh whelhor specified herein or nol. The granting of e pertnll does not presume <br />lo givo aulhority lo violato or cancol tho provislon o( any othor stale or local law regulaling constructlon or the peAortnance o( <br />conslruction. That I am aulhorizod by Iho ownor of Ihis proporty lo perfortn lhe work for which applicatlon Is made and I comply wilh lhe <br />Stato Cantractors Law t$.z7 RCW apd 29�.20o WAC. <br />/f <br />