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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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # - PERMIT # <br />1021 Se &f 14^1, 0 29 0900 oa3 607 00 <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />,ZGC Glo&-1°2,13 <br />IV&ZZ' <br />TENANT NAME I CONTACT FOR -PERMIT PHONE <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />�D�a����S f�•er, �T¢r �m.-�' 2POE 3.Caxa�►,,3�, ?r/u �a GuT26 <br />� Y4- <br />CONTR. LICENSE # <br />0'eAe�lvsC_-21.3.V5 <br />USE OF BUILDING HEAT SOURCE CONT"CT PRICE OF WORK <br />,i Electric J)L Gas _ Other s� h vo a /z <br />_ Z 40S <br />WORK DESCRIPTION <br />URIEVII:j1►VI <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 tray <br />Sink (service/bar/mop/etc.) <br />Backfiow preventer <br />Urinal . <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />/ <br />Z <br />/ <br />NO. i TYPE OF FIXTURE OR ITEM <br />_ A/C - air handling units <br />Forced air systems <br />Gas piping — F' a - <br />y Water heater X Z-e <br />L Gas fireplace <br />v Gas range <br />Clothes dryer <br />v Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater ow — <br />Boller <br />_ Refrigeration <br />_ Woodstove <br />_ Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />0 <br />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 Law 18.27 RCW and 296.200 WAC. <br />