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F .-RMIT APPLICATIkA <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 -DEBIT & CREDI r CARDS ARE NOT ACCEPTED <br />SITE ADDRESS VO_ 90 �S-C <br />i <br />PARCEL TAX I.D. # <br />I PERMIT f ��l <br />v/ YJ �lJ <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DES C. <br />OWNE ADDRESS CITY/ZIP PHONE <br />U Gf1610 D a5s--- 7ro <br />TENANT NAME <br />I CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE 0 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />I — Electric Gas Other <br />I <br />WORKD C� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO, TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavetory (wash basin) <br />Gas pipirT <br />Shower <br />L <br />Water healer �^ <br />_ <br />Kitchen sink 8 disposal <br />L <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />Clothes washer <br />Colhes dryer <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/bar/mopio!,..) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other _ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify that 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. The granting of a permit does not presume <br />to give aull iorily to violate or cancel the provision of any other stale or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and 1 comply with the <br />factors Law 18. CW and 296200 WAC. <br />it nature of wner on ractorl uthorize gent Date <br />