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ARMIT APPLICATI N <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 />APPLUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS `ram' 7 v ) 7 v ' ` "' 1 PARCEL TAX I.D. # PERMIT # <br />4903 �)INS /D , car <br />LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION # <br />DESC. <br />�� ( f'f G <br />TENANT NAME CONTACT FOR PERMIT PHQNE / <br />Ax?�, ft-�' S7� <br />E-MAIL <br />CO �`� (NG <br />TR. LICENSE # <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />m f (:�' _ Electric _ Gas _ Other /j fO G <br />WORK DESCRIPTION <br />ice's r AL�t - L- C- T (LTV <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 />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <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 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 />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces 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 property to perform the work for which application is made and I comply with the <br />State Contractors L 8.27 R and 296.200 WAC. <br />W - Id, ,% <br />