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PERMIT APPLICATION <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 />SITE ADDRESS I PARCEL TAX I.D. A <br />LOT NO. ( BLOCK ( TRACT <br />DESC. <br />Aittev'tC4.,�,1 bouev(o <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />C(eac_vvp�ve. Syd 12o9'aJ 300-6011-8`�103 <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE 0 <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />1 L� <br />Electric Gas _ Other 2 I C'P� <br />WORK DESCRIPTION $vim, 1 —IDS _K�,1�ti`� <br />�� BuL u�CSs�tvlc� LL��tytp� �(C)MI <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />_ Shower <br />_ Kitchen sink & disposal <br />_ Dishwasher <br />_ Clothes washer <br />_ Laundry bay <br />_ Sink (service/bar/mop/etc.) <br />_ Backflowpreventer <br />_ Urinal <br />Drinking Fountain <br />Floor drain <br />_ Grease trap <br />_ Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air sys!ams <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cenlity that I have read and examined this application and know the some to be true and correct. All provisions of laws and <br />ordinates governing this t e of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />S <br />aqaulhcntytovi ate or noel the provision of any other state or local law regulating construction or the performance of <br />st cbon. That 1 a author ed by the owner of this property to perform the work for which application is made and I comply with the <br />o ontractors Law 6.27 CW and 296.200 WAC <br />1 <br />�L <br />