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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 - vmmeverettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 1-2- ` n Q7 <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />�� el- N,o�l a Ta <br />LEGAL LOT NO. BLOCK TRACTOR SUBDIV.SION # <br />/S�/� r G✓� �(/io�J i/�� y,,�y c./cs�ta�,�7.c9/ Y?l-7�J fp'as7 <br />TENANT NA/-//'"( ( �/ /G ,/ IV�TACT FOR �41PERMIT PHONE <br />E-MAIL <br />CONTRACTOR ADURt55 GIITILIY YRUNh <br />C��,���'� �%kclurn c ?NC, C;2�a o eA/� r K: L/.+-,. d✓9 ��oBT YJs 7y,�G�y7 <br />CONTR. LICENSE # <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />/A; /- Sa /U� _ Electric �4 Gas _ Other 14 D O v <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <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 heater <br />Sink (servicelbarlmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />_2 <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <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 cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates 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 of this properly to perform the work for which application is made and I comply with the <br />Slate Contractors Law 18.27 RCW anif 296.200 WAC. <br />/.?- //- 0 7 <br />1 <br />1:2 <br />