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ADDRESS/, Y I, <br />�NO. <br />u i n,� <br />TENANT NAME <br />� <br />CONTA. <br />USE Or BUILDIN6 <br />l�r �;l���t'� <br />F�ERMIT APPLICATION ���`�-� �''�yv' �� <br />CITY OF EVERETT PERMIT SERVICES �C1�'��`t� ���1� <br />3200 CEDAR STREET, FVERETT, WA 98201 <br />425-257-8810 — FAX 425 257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 6`� b— <br />PARCEI TA�X D�. �N <br />�) ;,1L���uU��l.r (l� <br />BLOCK T1iACT Ufl SUBDIVISION / <br />�o <br />auATE2 �1f�ir�; <br />WORK DESCRIPTION !- <br />[r7 <br />� � �Ir; � i�)p <br />NO. I TYPE OF Fl%NRE OR IiEM <br />loilel <br />BnOilub <br />L�mlory (wash basin) <br />Showcr <br />Ki�chen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />� Waier healer <br />Sink (service/badmop�etc.) <br />l3ackllow prevontcr <br />Uiinal <br />Ihinhing Pounlain <br />floor drain <br />Groesc Ir;ip <br />Rool drains <br />Olher <br />��'7`Jy�' PI s'u� i <br />CONTACT F R oERMIT, <br />acci l,�l'll P__ IS <br />� I S�u�kr1�`ra <br />/�e/IC vccc <br />HEATSOURCE <br />�Glcetric ___ Gas ._ Olhcr <br />PHONE <br />l.�a 9�ia5 <br />PEAMIT N <br />�[X1c�n�C'7 <br />ya�:�4�-�oiv <br />CONTRACT PHICE OF WORK <br />J`��rJ4- <br />r,'��t t l 1���{ ������ ��.�� �-��- <br />NO. I TYPE OF FlXTURE OR ITEY <br />_ NC - air handling units <br />_ Forced air syslems <br />Gas piping <br />_ Watan c�a�or <br />Gas lireplace <br />Gas rango <br />Clolhos dryor <br />Rango hood <br />EMhaust laa <br />Heat pump <br />Unit hoatar <br />Bollar <br />Refrigetalion <br />Woodstc��e <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />�� I hereby ceritity Iiia1 I I�avo reed and examinod this applica�ion and know iho same to be true and wnect. AII provislons ol laws and <br />' orAinxes poverninp this type ol work �ril bo complied wilh whether specified homin or not. Tho granling al a pormit does not pmsumo <br />to yive au�hority �o violulo or cnncel Ihe y�ovision ol nny othar s�ato or local law regulating wnsiruclion or Ihe podormanca ol <br />conslruclion. Thal I am authorized b�• the owner ol lhis pmperty to podorm the xrork lor whidi application is mado and I comply with Ihe <br />Stale Conlrac`o's Law �B.27 HCW and296.200 WAQ. ���/ ` <br />-���t<<, � �dr�l r(l'�� «_���'� ' o� � <br />