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SITE ADDRESS <br />83`>< BoTM <br />LEGA LOT NO. <br />DESC. 3 — C % <br />OWfIER <br />—�J <br />�?QUr✓p ✓/• u <br />TENANT NAME <br />/U/ <br />CONTRACTOR <br />CONTR. LICENSE Al <br />USE OF BUILDING <br />WORK DESCRIPTION <br />PERMIT APPLICATI6N <br />CITY OF EVERETT PERMIT 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 />S,-ki '-r .3CO I a kbrci 7Av r . <br />BLOCK <br />CONTACT FOR PERMIT <br />/.,cq�ADDRESS <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (service/bar/mop/etc.) <br />Backfiow prevonter <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ Electric _, Gas Other <br />O PERMIT# <br />So(.vk-00) <br />CITY2IP PHONEa <br />PHONE <br />�fas �Ys--yZ -/z <br />CITY/ZIP PHONE <br />1 <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />rvi. — air nana ,ng units <br />Forced air systems <br />_ Gas piping <br />_ Waterheater <br />_ Gas fireplace <br />_ Gas range <br />_ Clothes dryer <br />_ Range hood <br />_ Exhaust fan <br />Heat pump <br />Unit heater <br />Boller <br />_ Refrigeration <br />_ Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE 19 31105 <br />I hereby ceritify [hat I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. Thr• granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating-onstructlon or the performance of <br />construction. That I am auth ed by the owner of this property to perform the work for v, hich application Is made and I comply with the <br />Stage QonNactgrs Law and 296.200 WAC. <br />