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SITE ADDRESS <br />LOT NO. <br />TENANTNAME <br />�/D49�cLle�.S p�i <br />P�RMIT APPLICA <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 />PARCEL TAX I.D. # <br />BLOCK ' I TRACT <br />Z Zo Z � <br />CONTACT FOR PERMIT <br />cJi✓n $� <br />ccjG(9 Tf1/1�Sal�( f'Ii��l�� l(c��/I��PzP <br />CONTR. LICENSE # � . „ _ � ... .�r, � � <br />USE OF BUILDING <br />� c� � �'� <br />WORK <br />NO. I TYhE OF FIXTURE OR ITEM <br />� Toilel <br />Bathtub <br />� Lavalory (wash basin) <br />Shower <br />Z F;ilchen sink 8 disposai <br />Dishwasher <br />Clolhes washer <br />� N'aler huater <br />� Sink (serviceNadmop/etc.) <br />�ackflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />� Grease lrap <br />Roof drains <br />Olhy.r <br />� 7�E%� (�� <br />% ` 7--D �v <br />PERMIT i{ <br />PHONE <br />CIlY21P PHONE <br />r1�2G'/�7�� u1�c. <br />�{25-3� <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />�O <br />� Eleclric _ Gas _ Other �� �— <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C – air handling unils <br />Forced air systems <br />Gas piping <br />W ater heater <br />Gas firepiaco <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boilcr <br />Retrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES -fAX CODE IS 3105 <br />I hereby cerili(y ihat I ha�e read and examined this application and know the same to be We and corcect. All provisions of laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give aulhorily lo violale or cancel lhe provision of any olher state or loral law regulating construclion or ihe performance of <br />consWction. Thal i am aulhorized by lhe owner of this property to pertorm the work for which applicalion is made and I comply with the <br />State Co ractors Law 18. CW and 296.200 WAC. <br />,-.l� P . / �. _ _ . . ., - - <br />