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SITE ADDRESS <br />��/O/S <br />LEGAL LOT N0. � <br />DESC. <br />TENANTNAME <br />PtRMIT APPLICATIC�N <br />CITY OF EV�RETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERFTT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� �U 1 � v IS <br />���� �� �� <br />AIOCK <br />� rP <br />CQNTR. LICENSE N /�,��� � � <br />USE OF BUILDING <br />� <br />WORK DESCRIPTION <br />PARCEL TA% I.D. li <br />OC�s y j D(' <br />TRAC? OR SUBDInVISION N <br />R/.l).JMii(J /� <br />3 � >E /�,�s <br />CONTACT FOR PERMIT <br />r- �,'., �.� <br />PHONE <br />; ///11L <br />�— <br />HEATSOURCE <br />Elec�ric _ Gas _ O�har <br />� <br />_ ;; i c, _,�_.. <br />NO. I TYPE OF FIXTURE OR ITEM <br />1_ Toilet <br />Bathtub <br />N� Lavalory (wash basin) <br />_� Shower <br />� Kilchen slnk 8 dis�ws21 <br />� Dishwasher <br />I Clothes washer <br />% Walor heater <br />Sink (servicelbar/mop/elc.) <br />Backllaw preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof dralns <br />Olher <br />CONTRACT PRICE OF WORK <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — eir handling unils <br />= Forced air syslems <br />�Gas piping <br />Waler healer <br />Gas ilreplace <br />T Gas range <br />t Clolhes dryer <br />Range hood <br />� Exhausl fan <br />Heat pump <br />Unit healer <br />Boller <br />� Re(rigeratlon <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALE9 TAX CODE IS J10S <br />I hereby ceritify Ihat I have read and e�amined this application and know Ihe same lo be true and correct. All provlslons of laws and <br />ordinaces governing Ihis lype of work will be compiied wilh whelher specilied herein or not. The granling ol a permil does nol presume <br />to givQ authority to violate or cancel the provision ol any other stale or local law regulaling conslrucdon or the pertortnence ol <br />construction. That I am authorizod I�y tho owner ot this property to perform Ihe work for which epplication is made and I comply wilh the <br />Slale Conlraclors 4xw,18.27 RCW and 296.200 WAC. <br />/ <br />_� � — S� U � <br />Signp re ol nodContraclodAulhonzed Agent Date i�L <br />