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I�ErtMIT APPLICATIO�� <br />CITY OF EVERETT PERMwT SERVICES <br />3200 CEDAR STREET, EVEREIT, WA 98201 <br />425-257-8810 — FAX 425-257-II857 — www.everettwa.org 5„ ���j 7 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SI7E ADDRESS <br />LOT NO. <br />CONTRACTOR �/ /1/) <br />„� <br />CONTR. <br />USE OF BUILDING <br />.� -�—�- � � �-'��� ��� <br />WORK DESCRIPTION <br />�� <br />PARCEL TAX I.D. # <br />BLOCK TRACT <br />ADDRESS <br />L �l .5^ � � <br />CONTACT FOR PERMIT <br />�nn .�t ADORESS <br />HEATSOURCE 0' <br />_ Electric �as _ Other <br />c�Cva .�L C.�,�e� <br />� ..i -� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Ciothes washer <br />laundry tray <br />Sink (service/har/mop/etc.) <br />Backflow praventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />PERMIT Ji <br />�z <br />PHONE <br />CITY2IP PHONE <br />y�s 2s�� 66� G <br />�r�na L �- 9Sl.Zo l <br />�}-- � i�'Q-�'� / <br />.�1�64�-CZLC�C S�f—� <br />CONTRACT PRICE OF WORK <br />. :- <br />• � i, <br />i__ <br />NO. i TYPE OP FIXTURE OR ITEM <br />A/C — air handling un(ts <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas flreplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Bo(ler <br />Refrigeradon <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3103 <br />1 herahy ceri6fy that I have read and examined this appllcatlon and know the same to be W e and correct. All provis!ons of laws and <br />ordi. --es governing this type of work will be complied with whethar specified herein or not. The grantlng of a pertnit does not presume <br />to give ,'hontv ro violate or c2ncel the provision of any other state or local law regulaUng consWctlon or the perfortnance of <br />constructl��.. at I am authorized by the owner of this property to perform th5 �vork for which appllcatlon fs made and I comply with tha <br />Slate Contractors Law 18.27 RCW and 296.200 WAC. <br />