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PE.r�MIT APPLICATIG�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREE-T, EVERETf, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.e:•erettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESlS � � <br />i, <br />r3 G''S <br />LEGA LOT N0. <br />DESC. <br />l � <br />G��' �%�G-� c• <br />TENANTNAME <br />CONTRACTOR <br />CUNTR. LICENSE p <br />USE OF BUILDING <br />WORK DESCRIPTII+N <br />� <br />1_�� � <br />/ PARCEL TAX I.D. # <br />��L[! . <br />BLOCK TRACT <br />ADORESS CITY/ZIP <br />> ✓ v� <br />ICONTACT FOR PERMIT <br />ADORESS CITY2IP <br />� HEATSOURCE I <br />Electric Gas Olher <br />VIIT # <br />SO ( -p <br />PHONE <br />PHONE <br />CON'f RACT PRICE OF WORK <br />�/LI�C�F � `>> f.�oa ' �`�7'O/� <br />NO. I TYPE OF FIXTURE OR ITEM <br />TOilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Ciothes washer <br />Laundry trey <br />Sink (service/badmopletc.) <br />Backflow preventer <br />Urinal <br />Dnnking rountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Olher <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — alr handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Wc�dstove <br />Olher <br />CI �Y OF EVERETT LOCAL SALES TAX CODE IS ]105 <br />I hereby ceritify that I have read and examined this application and know the same lo be true and correct All provisions of laws and <br />ordinaces governing this rype of work will be complied with whether specified herein or not. Tha grenling of a permit does not presume <br />to give authonty to violate or cancel the provision of any oth�r s[ate or local law regulating construcUon or the performance of <br />censtruction. That I am authorized by the owner of th�s prop�:rty to perform the v�ork for which applicaQon is made and I comply with the <br />State Contractors Law 1827 RCW and 296.200 WAC. <br />Signature of OwnenGintractorrAuthonzed Agent Datz <br />