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• <br />PER��T APPLICATI�N <br />GITY O�' EV�ERETT PERMRT SERVIC�S <br />3200 CEDAR STREET, �V�RETT, WA 9820'f <br />425-257-8890 — FAX 425-257-8857 — wvuw.everettwa.org <br />APPLICATIONS ARE qCCEPT�D �ROM 8 AM TO 4 PM <br />Sir� A��R�ss � ' <br />� � <br />�E�� �OT No. B�OCK <br />D�5G. <br />aw�t�� <br />� <br />'i'�NANT NAME <br />C NTRA ToR ��p� , � <br />CONTR. LICENSE# <br />USE OF BUILDING <br />PARCE� TAx �_p, # <br />�ACT aR SUBnIVISroN # <br />CONTACT �OR PERMiT <br />i � fYl,a �'. C� �LI'Ll'�,�..�1 <br />A �ftES �i ��� J � <br />PL <br />N�AT SOUf2CE <br />,� Ele�tric � Gas _ Other <br />1 � K� qESGRIPTIOF( <br />� �-1��� "� c_��-e � 3 �.� <br />�`''�'P <br />�a• '1YPE oF FIXTURE OR 1TEM <br />� <br />� <br />I Oilet <br />Bamtub <br />�avatory (urash basin) <br />5hower <br />Kitchen sink & dfsposal <br />Dishwasher <br />Cfotftes wag�er <br />Water heater <br />Slnk (service/baNmop/etc.) <br />Backflow pre,�nter <br />Urinal <br />Drinking Fountain <br />FloOr drairl <br />Qrease trap <br />Raof drains <br />Oth�r <br />NO, <br />PERMiT # <br />; �_: <br />.� � <br />' + ,i , ' i �' t - �%li1 <br />PH�NE ���+ ac � � � l�?l�3 <br />E-MAr�.�Gi� t'Y1,i ����DI� 1�o_Al <br />���1'I-� P NE � , <br />�j �� l� � a�t� � � � � � c'.t: � <br />�CONi'RqCi pF210E OF WORK <br />�� O C� <br />TYPE OF F�j(nJRE pR Il'�M <br />AfG — air handling units <br />Forced airsy8tems <br />Gas pipiflg <br />Water heater <br />Gas firaplace <br />Gss range <br />CIo#hes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />BoifAf <br />Refrigeratian <br />Woods�ve <br />Other <br />CITY OF EV��E7T �OCAL SALES TqX CpDE 13 3185 <br />I hereby cer{t{y {hat I have raad and exarnined this application and knoW the Same to be true and correct All prpvisions af laws and <br />ordinances goveming thls type of wortc wlll be compfied with whether speclfied herein or not, 7he granting of a permit does not presume <br />� give authority to v�o�ate or canc�f the provfsion of any other stete or lor„af law regulating corsstn,ctlon or the pQrfo�panc6 of <br />con etion. That I am autho �" $d by the ovvner of thls property tq perfpmt the work for whicfl appficattpn is madg and I COmply wlth the <br />9%te ontracters Law 18,27 RCYW and 6_200 WAC. <br />� I ! i ► <br />