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SITE <br />LOT <br />CONTp. IJCENSE N <br />USE OF BUILDING <br />WORK DESCRIPTION <br />PERMIT APPLICATIUN <br />CITY OF EVERETT PE�MIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 96201 <br />425•257-8810 — FA� 425-257•8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />f �4c'1� �L�iC'S170c���oiGC: <br />BLOCK TRACi OH SUBDIVISION • <br />ADOflESS � <br />� euay- �i����17�5�� F(�Ill� <br />ICONTACT FO(i PERMR <br />'IIA��R.I'{L�t ���JN-��%��U+'���/4'l�l3fjlil <br />r nnf �i)(� — <br />–r I — HEAT SOURCE <br />Electric _ Gas _ Olher <br />NO. I TYPE OF FlXTURE OR fTEM <br />�_ Toilet <br />8athtub <br />Lavatory (Wash basin) <br />� Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />i Waterheater <br />Sink (service/bar/mop/etc.) <br />1_ Backllow preventer <br />Urinal <br />Drinking Fountain <br />; Floor drain <br />� Grease trap <br />Roof drains <br />Other <br />.�- a� Y ���.�. <br />PERMIT A <br />�� � <br />YZP PHONE <br />,�ds�i���z� <br />PMONE <br />Pnoneil�5� GOJ�Q <br />V y's�i7 <br />I �ONTRACT PRICE OF WORK <br />' �,�'G"I.L�L�. <br />p�p, I T'PE OF FI1CiURE OR ITEM <br />NC – air handling unils <br />Forced air systoms <br />Gas piping <br />Water heater <br />Gas freplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVEHETT LOCAL SALES TAX CADE IS 3105 <br />I lioreby ceritity that I have read and ozamined ihis applicaiion and know the same to be true and correct. All provisions of laws and <br />ordinaces goveming this type o( work will be complied with whather specilied herein or not. The granting of a permit does not presume <br />to give authoriry to vio�ate or cancel the provision ol any other state or laal law regulating consVuction or Ihe perlormance of <br />construction. TbBI I am a�l onzed•by the owner ol this property lo perbrm the work lor which application is made and I comply wilh the <br />State Conlradors Law iPl.�/!/g�CV� and 296.200 WAC. <br />i , '� � ,.,1': �\. �;' �%� %_ r55'i <br />