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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-89'.0 - FAX 425-257-8l;57 - www.everottwa.org <br />APPLIL'ATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS P,�RC TAX .D. <br />3osa $�Imorr4�. t-ane C C ��'j(,:��: L�GC-C�/(,�C��i'�� <br />BIOCK <br />�ESC. <br />'.�-i 2_ <br />TENANTNA�� � CONiACTFORPERMIT PHONE <br />�3.c+.4 �cLc.V<.-�w_ '{25-75'(-15$�' <br />CONTRACTOR ADDRESS CITY/LP PHONF <br />CONTR. LICENSE N <br />USE OF BUILDING <br />WORN DESCRIPTION <br />TYPE OF FI%TURE OR ITEM <br />ilet <br />Ihtub <br />varory (wash busin) <br />ower <br />Gien smk 8 disposal <br />�hwasher <br />>thec washer <br />undry tray <br />ik (service/bar/mop/etc ) <br />ckllow preventer <br />nal <br />nkmg Fountam <br />�or drain <br />�ase Irap <br />of drains <br />ier <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Eled�c � Gas _ Other <br />C tt oZ� � <br />N0. I TYPE OF FIXTURE OR ITEM <br />A1C — air handling units <br />Forced ah systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas renge <br />Clothes dryer <br />Range hood <br />Erhaust fan <br />Heatpump <br />Unit heater <br />Boiler <br />Relrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TN( CODE IS J106 <br />�� I hereby cenhfy Ihat I have read and examined this apphcahon and know the same to be true and corted. All provisions of laws end <br />. ordmaces goveming Ihis type ol work will be comphed wdh whelher speGfieG herein or not. The granting ol a permil does not presume <br />Ita grve authonly to violate or cancel the pmvision of any olher state or loral law regulaUng construdion or lhe periortnance ol <br />construdion That I am authonzed by the owner ol thls property lo perlortn Ihe work lor which applicafion is made and I comply with the <br />I Stale Conlractors Law 1Q,27 j�W v.nd 296200 WAC _� / <br />i ��yna�me ui �wne <br />�,.. . . . . .._ .. /. <br />IW <br />