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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 />_ APPL�CATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �,� ljJn,��'I � <br />SITE ADDRESS <br />LOT <br />DESC. <br />BLOCK <br />PARCEL TAX I.D. 8 <br />�cLron-4� li��cir�s Ona_.I.�-� 951H 4�54. NES�..��� 10� �nnlSeSla,,h.rs `��58 y�5453 i470 <br />TENANTNAME CONTACTFORPERMIT PHONE <br />�3��-�!_ �IAV..�.� �r2s- �sa- is�g <br />CONTHACTOR <br />CONTR. LICENSE • <br />USE OF BUILDING <br />WORK DESCRIPTION <br />IC <br />1:6�i�d�i7�3i3111:1��77i i3,'.l <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry trey <br />Sink Iservice/barlmop/etcJ <br />BackOow preventer <br />Urinal <br />Dnnking Fountam <br />Ploor draln <br />Grease trap <br />Rool drains <br />Olher <br />ADORESS <br />CITYILP PHONE <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Eledric ,�Gas _ Other <br />L`[�71 <br />TYPE OF fU(TURE Oti ITEM <br />FUC - eir �andling unils <br />Forced air systems <br />Gas piping <br />Waler healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heatpump <br />Unit heater <br />Boiler <br />Refngeration <br />Wootlstove <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS J106 <br />I hereby cenhfy Ihat I have read and exammed this applicadon and know lhe same to be Irue and corted. All provisions ol laws and <br />ordinaces goveming thls rype ol work vnll be �nmplied with whether specified herem or not The granting of a pertnit dces not presume <br />to grve aulhordy lo wolate or cancel Ihe provlsion of any olher stale or local law regulating construdion or the perlortnance of <br />construction That I am authonzeA by the owner ol this property to pedorm Ihe work for wfiich application is mede end I comply with Ihe <br />State Contraclory►awaB27 RCW and 296.200 WAC. , <br />�___. _ <br />- —�--"- <br />