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s <br />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 , PARCEL TAX 1.0; # PERMIT # <br />LOT NO. BLOCK I TRACT OR SUBDIVISION # <br />DESC.r ' I <br />OWNER ADDRESS CITY21P PHONE <br />Z 1 <-1AA ao 1-'1€\ [?r SO i� � r�"► i hl S 5 rH �f Ar+ t✓C ZcJ� <br />CANT NAME CONTACT FOR PERMIT PHONE <br />E-MAIL <br />CONTRACTOR ADDRESS P PHONE <br />S <br />AV ti lc)i�iLjS Cila, ► . 15it f.J 1t1 <br />C"NT L'E-� 2-0L-- � ti'�� 2oi4 <br />CONTR. LICENSE # C �_ 10 j <br />USE OF BUILDING <br />-3 <br />WORK DESCRIPTION <br />uu i �jy A -a re-4- <br />1A 4F- <br />HEAT SOURCE <br />Electric _ Gas _ Other <br />LaS Xqy 183., %Ll = 10/S,o35 <br />a) j-7-1 <br />NO. I TYPE`OF FIXTURE OR ITEM <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 />Backfiow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <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 cedtify that 1 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 foEywhich application is made and I comply with the <br />State,Contractors Law 1827 RCW and 296.200 WAC. <br />