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PERMIi APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />��, � �� � APPLICATIONS ARE ACCEPiED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />. - - - - _ _----- _._ _---- -- .., . <br />C� ?_� �-- �1 � �. w I (�J I� 4'j - L� '?� <br />LOT NO. I BLOCK I TRACT <br />DESC. <br />� V ,�,� r,,.j � i L <br />� <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />� � C� ��6 �-�5 L- ., rZi� � I � e-t .rt � S .� �� h i%L,� 7 c�, `�. 0 2 Z <br />CONTRACTOR AODRESS CITY121P PHONE <br />�J �� H. �L.-f e 5 F l'��. �� ���5. � �.� � S�w 7 t h��ro� 4J �. �f 8��5 7 �'t:� Z a 5" `s �.� � <br />CONTR. LICENSE # <br />N�r.�' H � K ��J .I % <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />�_�__i �y--� � .� � � _ Electric _ Gas _ Other � 1 r Z `I'� � � �� <br />WORK DESCRIPTION <br />� � s ��u I "G t � �.l' !� � � <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />fGtchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (senrice/baNmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinldng Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />��3��.,��) <br />NO. I TYPE OF FIXTURE OR ITEM <br />AlC - air handling units <br />Fcrced 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 />Refigera6on <br />Woodstove <br />Other <br />, CIiY OF EVEREIT LOCAL SALES TAXCODE IS 3105 <br />I hereby ceri6fy that 1 have read and examined this applicaGon and know the same to be true and correct. All provisions of laws and <br />ordinaces goveming this type of work will be complied with wh�ther 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 tegulating construc6on or the perfortnance of <br />consVucGon. That I am a orized by the owner of this propeciy to perfortn the work for which applicadon is made and I comply with the <br />State Contractors���6W and 296.200 WAC. � , <br />7 f� / 3 <br />