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SlTE ADDRESS <br />aa��- ►� rn <br />LEGA LOT NO. <br />DESC. <br />TENANT <br />PERMIT APPL1CATION <br />CITY OF EVERETT PERM17 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 />BLOCK <br />IiVI� 1 RI�M 1 vn <br />ReclWo��d Cont�act�no� <br />CONTR. IICENSE M <br />p r ri i�� �,r * 4 3 <br />USE OF BUILDING <br />s..yl� ����ry <br />PARCEL TA% I.D. k <br />TRACT OR SUBDIVISION M <br />(� -11 b�r St � <br />ICONTACT FOR PERMIT <br />1 b 1 q V�i�tU Del CYh�r <br />HEATSOURCL <br />,� Electric _ Gas __ Uther <br />WORKDESCRIPTIJN ��`x�� r/�f,(��i����� <br />�uc�� <br />�a�K,�' ��u�� �, s��o��X �o� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Oathtub <br />Lavatory (wesh besin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Waler heater <br />Sink (servlcefbarlmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drein <br />Grease trap <br />Roof drains <br />Olher <br />InC� �-rc�r <br />PERMI7 p �, <br />d e� D <br />PHONE <br />�u8 ya� - �8-9av� <br />HONE <br />E-MAII n <br />—�{��_a.�'.�' V � �3 - G�'� <br />na��,la�,rl 9Po�$.�_ <br />I:ONTRACT PRICE OF WORK <br />1y4� �� � a�rrl� 1�� x��\ ��n�� Ro�Ni <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling uni;s <br />Forced eir systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clo�hes dryer <br />Renge hood <br />Ezheusl fan <br />Heat pump <br />Unil heater <br />Boiler <br />Relrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE 19 ]106 <br />I hereby cerlify Ihel I have read end examined this applicalion and know the same lo be true end cortect. All provislons ollaws �ind <br />ordinances governing Ihis lype oi work will be complied wilh whether specified herein or not. The granting of a pertnit does nol presume <br />lo give authority to vidate or cancel Ihe provision of any alher slete or locel lew regulating construction or Ihe performance+ of <br />construction. Thal I am authorir.ed by the owner ol this property to perform Ihe work lor whlch epplication Ia made and I comply with Ihe <br />Slate CoNrectors Lew i� RCW end 290.200 WAC. <br />� o�-ao1� �Iz <br />