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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 everetiwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TA� I.D. p P IT p <br />ii?z '15+�• sfi �YJ Ever�' wa. ?r2� 4t2 003 0�000 �� j�� <br />I LGAI <br />n� sc <br />� <br />:�.� <br />� C��� <br />NAME <br />�s �� <br />OLOCN <br />CONTACT FOR PERMIT PHONE <br />�ev� ��'e+f'�ie� 4-26•'1�P� • 15� <br />C NTRACTOR ADDRESS CITYIZIP PHONE <br />��►�n� �: � �.�.��. ��,Wa.q�o2o �25-1�1�-500� <br />CONTP. LICENSE 1 <br />l+AMMEI �o'13JA <br />USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br />GVii1►L{1 [lednc i:Gas Olher ����yvo.� <br />WORK DESCRIPTION 'f^�� � <br />��101� O�!'M D�jLe �d <br />� � r�''�"�� <br />NO. I TVPE OF FIxTURE OR IiEM <br />Totlel <br />Bathlub <br />Lavatory (wash basm) <br />Shower <br />Kdchen slnk 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (serncelbar/mop/etc � <br />fiackfow preventer <br />Unnal <br />Dnnking Founlam <br />Floor drain <br />Grease Irap <br />Roof drains <br />Other <br />� <br />� r•. � <br />NO. I TYPE OF flJ(TUHE OR I1EM <br />A/C — av handhng units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas f�replace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Und heater <br />Ooiler <br />Refrigeration <br />Woodstove <br />Other <br />CIiV Oh EVERETT LOCAL SALE9 TA% CODE 19 J106 <br />I hereby centdy that I have read and ezamined this apphcation and know the same to be true and wrrecl All prowsions of laws and <br />urdinaces govermng this rype ol work wdl be complied wdh whether specihed herein ar not The grantmg of a permd does not presume <br />lo gwe authonty to wolate or cancel U�e pwwsion of any other state or local law regulating construchon or the performance of <br />constructwn That I am authonzed b Ihe owner of Ihis property to perform the work lor which application is made and I comply with the <br />Slateqontraclor:J-aw ti3Ri�,:ly �A 296 200 WAC <br />L- <br />