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SITE ADDRESS <br />NO. <br />NAME <br />PtRMIT APPLICATIC�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8057 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM A AM TO 4 PM <br />PARCEL TAl( I.D. # <br />BLOCK I TRACT <br />CONTACT FOR PERMIT <br />�-a3�o <br />PERMIT p <br />PHONE <br />inmrllA,l vIA+U l-l.f wl 4�1('P,ti't1 CV" ��.C. v r � 7� uc.�Uu � i�- o �� � o�v-� <br />CONTRACTOR � AOURESS CITYIZIP PHONE <br />CONTR. LICENSE p � n � 1,` _'nn� 1 �4 J�C �'n -1 �Y JO �,3�+ ' "` ����� � � �5� <br />1� 1l. 1 r� l '4 ZS—�S <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />�,� a;. � �_�n _ Eloclric � Gas _ Othor '� �P��, �� i� • ��� <br />WORK DESCRIPTION V � J��l.0 ��I , 1�— �� a 1 U� � �J�Y� �M � <br />CC.�,��-�. ��_�I . <br />NO. I TYPE OF FIXIURE OR ITEM <br />Toile� <br />�alhlub <br />Lavatory (wash basin) <br />Sl�ower <br />Kilchen sink 8 dis{�sal <br />Dishwasher <br />Clothes washor <br />W aler heater <br />Sink (sorvice/badmopletc.) <br />Backllow prev�nler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grctase Irap <br />Rool drains <br />Othcr _ _ <br />NO. I TVPE OF fl%TURE OR ITEM <br />A/C - air handling units <br />Forced air systoms <br />Gas piping <br />Water heator <br />Gas firoplace <br />Gas range <br />Clolhos dryor <br />Ranyehood <br />Exhaust(an <br />Hea� pump <br />Unil-heater <br />Boiler <br />Rolrigeration <br />Woodstove <br />CITV OF EVEREtt LOCAL SALES TAX CODE IS �105 <br />I hereby corilify Ihat I have read and examined ihis app6calion and know Ihe same to be true and corrocL AII provisions of laws and <br />ordinacfls govorning Ihis lype o( work will be complied with who�her specified herein or noL Tho granting of a permil does not presume <br />lo yive 0u(horily to violata or cancel Ihe provision of any o�her slale or local law regula�ing consWction or the performance of <br />r.ons clu�n. Thal I am aulhnnTed by Ihc� owner o( this proporty to peAorm tho work lor which application is made and I comply wilh lhe <br />Sla Con�raclors Law I8.�`� (.W . nd 29/6'� 00 WAC. <br />,�!i:v��i.' I �ti�( l� 3 -0__�. <br />��Z <br />