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SITE ADDRESS <br />7g0,� � <br />�RIVIIT. APPL�ICATIi�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wvrN.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX 1.0. # <br />TRACT OR SUBDIVISION � <br />v�rn�rt � r ft ..__..__ � 9�zo <br />H y q�� n,� o� G �•-+'., 7suo �v�,yv��h �^'�� E✓u4ff T _ <br />TFNANT�NAME � � CONTACT�FOR�PER�diT ''� PHONE�Zr 483=S6S7 x Z <br />' �-i-y�h�u� d,� �i/•✓�I ���I /���'�;� e.r,�a� 6.��@ad✓�'�✓� .h�7" <br />.,..,.,..,...,.,,.p�<n��( F��� P��t�firon <br />CONTR.LICENSE# A(JVqI✓� F I�'y g(j <br />H r <br />USE OF BUILUING <br />WORK DESCRIPTION <br />R�IrO Vt <br />TYPE OF FIXTURE OR ITEtA <br />iaue� <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposai <br />Dishwasher <br />Clolhes washer <br />Waler healer <br />Sink (service/bar/mop/etc.) <br />Backflow prevcnter <br />Urinal <br />Orinking Founlain <br />Floor drain • <br />Grease Irap <br />Roof drains <br />Olhcr <br />HEATSOURCE <br />Elec�ric � Gas Other <br />woo��„��.�I� � 4z r— ��3— s—E�r� <br />W�, ���7? <br />TYPE OF FIXTURE OR ITEIr1 <br />iv� — au iianwiny u���ia <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gasrange <br />Clolhes dryer <br />ftange hood <br />Exhaust (an <br />Heat pump <br />Unil heater <br />Boilor <br />Rofrigeralion <br />Woodstove <br />rnna� .. . ... <br />CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br />I hereby ceritify thal I have read and eramined this applicalion and know the same to be lrue and correcl. AI� provisions of faws and <br />ordinaces governing this type of work will be complied with whefher specified herein or not. The grantin9 of a permil does not presume <br />to give aulhonty lo violate or cancel lhe provision of any other state or local law regulaGng consiruction or the performance of <br />construction. Thal I am authorized by the owner o( this property lo qeriorm Ihe r�ork lor which applicalion is made and I comply wilh the <br />Slate Conlracto s w 18.27 RCW and 296.200 WA:;. <br />�fi� ��i�. I l� f�/l3 � . <br />A <br />