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SiTE ADDRESS <br />NO. <br />PtRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERFTT, WA 98201 <br />425-257-8810 - FAY. 425-257-8857 - www.everetiwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK I TRACT <br />PARCEL TAX I.D. # <br />PERMIT p <br />�� <br />TENANTNAME CONTACTFOR PERMIT PHONE <br />�b �ru.v ��'7s �f� �� y� <br />CONTRACTOR N'.f.� j�� ADORESS � CITY2IP PMONE <br />"� ► �.�i aPu�d ��t � ,�li�s,,;�P y��7�o-Y��o <br />CONTR.LICENSEp ��Sy� �' 15C�L� �����/ <br />USE OF BUILDING <br />/h P ��..,; ��jii <br />WORK DESCRIPTION <br />N0. I TYPE Of FI%TURE OR ITEM <br />Tai�ef <br />�athtub <br />La�•atory (wasl� basin) <br />Shower <br />Kllchen sink 8 dis�osal <br />Dlshwashor <br />Clolhos washor <br />Wator healer <br />Sink (sorvlcePoarlmop/otc.) <br />Backflow provonler <br />Urinal <br />Drinkinp Founlaln <br />Floor drain <br />Groasotrap <br />Rouf dralns <br />Olher __ <br />HEAT SOURCE I 1CONTRACT PRICE OF WORK <br />_ [Icc�rir. � Gns _ Olhor !'/ ����� <br />�3 � <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — nir handling unils <br />�Forced air syctems <br />Gas P�P'��J <br />N�alar heatar <br />� Gas fireplaco <br />Gas rango <br />Clolhos dryor <br />Ranc�o hood <br />Exhauslfan <br />Healpump <br />Uni� healor <br />Boiler <br />Rafrlgeiellon <br />Woodstove <br />Othor <br />CITY OF EVERETT LOCAL SALES TA%CODE IS 7105 <br />I horoby cerillly that I have read end examineA Ihis application and know lhe same to bo truo end conecL All provisions ol Inws and <br />orAinar,os governing thls typo ol work will be complied wilh whether apecifed hareln or noL The granting ol e permit d.�os not prosume <br />to givo euDiority to violate or canr,el Ihe provislon of any olher slate or local law regulating conetructlon or ihe pedom�.ance of <br />construction. Thet I am aulhorized by the ownor of this property to perform lhe work far which eppllcetion Is mado and I cnmply with lhe <br />Slal� C c 18.27 RCW anA 90 W�C. <br />�� 3/�/0� <br />SlgneWre ol OwnedCaniraclor/Aulharimd Agenl Oete 1/ <br />� "?i <br />