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PERMIT APPLICA riON <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 j1 -/6 - /0 <br />SITE ADDRESS PARCEL TAX I.D. X PERMIT # <br />ujs n ^`' s4 3f-1 a s Wao IOII-03 <br />LEG,Aq LOT NO. BLOCK TRACT OR SUBDIVISION N <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />L'X'. nCL Y-49 Y L115 cj d.,e bo 5 f r yqj:+� gj bdoSs .— <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />y1EbL:Kn� �tloluEU2�j►�en(�Xwlµ'� COW-N t1Z�5 2St-I�co} <br />M <br />OF <br />WORK. DESCRIPTION <br />HEAT SOURCE <br />_-k/Eleclric —Gas —Other <br />VL,a0ctciIr,S cc 0 <br />NO. I TYPE OF FIXTURE OR ITEM <br />CONTRACT PRICE OF WORK <br />�I 'is7yC) <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (service/bar/mop/etc.) <br />Backflow preventor <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />— <br />— <br />_ <br />_ <br />— <br />_ <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas firaplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other _ <br />— <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinsces 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 authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner J this property to perform the work for which application is made and I comply with lh <br />3t2tafionlraclerslaw_18.2?-R6W and 296.200 WAC. <br />