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E ADDRESS <br />�% � ,�u / 1, <br />IA ]LOT N0. <br />NAME <br />P�RMIT APP�ICATION <br />CITY OF EVERET i PE�RMIT S�RVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTFD FROM 8 AM TO 4 PM <br />BLOCK <br />CONTRACTOR � fGf 5��� ^ ` <br />., <br />CONTR.LICENSEM �pK CI C/�r4a �j <br />����y F <br />USE OF BUILDING <br />S�h /�� � ,�� <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXlURE OR ITEM <br />Toilol <br />oau,i�� <br />Lavatory (wash bas n) <br />Showor <br />Kitchon si�k 8 dis�isal <br />Dlshwashor <br />Clolhes washer <br />W ator hAater <br />Sink (servicefbar/mop/otc.) <br />Bnckflow pravoNar <br />Urinel <br />Drinking f'ountain <br />Floor drain <br />Groasutrep <br />Roof dralns <br />Olher <br />PARCEL TAX I.D. q <br />. � � ; t' r <br />(�,' )C ("(.�if-' ��' C�t <br />TRACT <br />CONTACT FOR PERMIT <br />�b d��, <br />AUpRESS <br />� 0 �I (�Pu C� A✓f �`� <br />�LG <br />HEATSOURCE <br />_ [Ieclric � Gas _ Olhor <br />F ERMIT p <br />Cc 1U �+ <br />PHONE <br />�sva� �� y� <br />CITY2IP PHONE <br />�,G�s���'' v�.1�o�%�o <br />9 �1�0 <br />CONTRACT PRICE OF WORK <br />�� %�/T7/7/�'J <br />I.��S � �3 � <br />MECHANICAL <br />NO. I TVPE OF FIXTURE OR ITEM <br />A/C — alr hendling units <br />� forced alr sysfems <br />„ � Gas plping <br />V. alor heator <br />]_ Gas firoplaco <br />Gas rango <br />—T-- Clothes dryor <br />Range hood <br />Exhaust lan <br />Nealpump <br />Unl� heater <br />Boller <br />Relrigeratlon <br />Woodsluve <br />Olher <br />CITY OF EVERETI LOCAL SALES TA% CODE IS J105 <br />I hereby cerltify that I have read and exemined this applicallon and know lhe same to be true and corrscf. All provislons o( lews end <br />ordinacos govorning this typo of wark will he complioA with whether specllled hereln nr not. Th� granting ot e peimll daes not presume <br />to glvo euthodry lo violate or cancal the provislon ol any other state or local law ragulating constructlon or the pedormance ol <br />conslruction. That 1 am authorized by tho owner ot lhis property to perform Ihe work for whlcli applicetlon is mede and I comply with lhe <br />Stalo C r,�,�J�tw tfi.27 R/CV� flnd 90 WAC. <br />�'����% <�i J�///� J% <br />��L <br />