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SITE ADDRESS <br />IfGAL LOTNO. <br />�rsc ^� �� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STR[ET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �- Q�'I � <br />PARCEL TAX I.D. p PERMIT p �"' <br />,_ s�, 'o�og o0000 9600 •(tv(c• C,�r <br />BLOCK TRACT <br />�.I�����C.���{= t ���: i (' � _ <br />, , � , ., �`,L� �,i, <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE N <br />USE OF BUILDING <br />�::1 r�l i.,l��.. <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />i ouu� <br />Balhtub <br />Lavalory (wash b�sin) <br />Showcr <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washcr <br />LaunAry Iray <br />Smk (scrvicelbarlmop!c�c I <br />Bar.kllow proventcr <br />Unnal <br />Drinking FouNain <br />Fioor drain <br />Grease Ir�p <br />Roof dnms <br />Other <br />„ ,_ <br />. , •a �� 5 �. <br />CONTACT FOR PEHMIT <br />J(� �l' �-i'p11U�`�� l <br />ADDRE55 <br />i �. �= �� t= i i <br />CNi�/tdl� <br />7✓� 2u� y7b7 <br />PHONE <br />�IZs ?tiS 9�67 <br />PHONE <br />H[AT SOURCE I CONTRACT PRICE OF WORK <br />t�u N� <br />Electric Gas Othr.r �- - � � � �� ��. `�'�� <br />TYPE OF FIXTURE OR ITEM <br />NC - oir handling units <br />Forced air systems <br />G�s piping <br />Waten c��ler <br />Gas Greplaca <br />Gas rango <br />Clolhes dryer <br />Hangc hood <br />Exhausl lan <br />Heat pump <br />Unil heater <br />Boilcr <br />Refnger�lion <br />Woodslove <br />Olher____ _ <br />CITY OF EVERETT LOCAL SAlES TAX CODE IS ]105 <br />� I he�eby cenhfy �hat I have roaA and examined �his application and hnow the same lo be true and currett. All provisions ollaws and <br />! nrd�nar.es goveming Ihis �ype of work will bo complied wi�h whethor speci0ed hermn or not. Tho granting ol a pormd does no� presumo <br />I� Io give nulhonty to violale or r.ancel Ihe provision oi any other slale or local I�w rogWating construchon or Iho periormance ol <br />�.unslruciron. Thn� I am authorized �.l�ie owner ol lhis property lo podorm Ihu work lor which �pplic�tion is made and I comply wnh Ihe <br />Statc Conq�cl rs Law 1827 RJ��nJ �nd 296/�l1b A(' � �7 / <br />--- ' J � 1 "% 7�/ .��� l�J � / � G' {L' <br />� 'oiynaWrColOwnCdCon�raclor/AulhOn od�gent Da�e <br />I I/• <br />. . .____.__. . _ _. . ________—__.________-_-__'_�.... <br />