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PtRMIT APPLICATIC�N <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 />RPPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />- .� �n. <br />LOT NO. � � BLOCK <br />1 PARCEL TAX I.O. # <br />��-> > ��`���. <br />TRACT OR SUBDIVISION il <br />�+. <br />PERMIT # <br />05-�71 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />CONTRACTOR / C�,�— pj^(; J�{���LpVis ADDRESS/S��j �,3 J CITY2IP PHONE <br />I J '�o E-hel � 9��� z/ <br />CONTR. LICENSE # ii �� 7— � J� J�/� �i ,! � <br />0` l ti � V <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />,1 �} �� <br />/�� ^ �� ���/�"' <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 6 disposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />Sink (serviceNadmop/etc.) <br />Backtlow preventer <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Greasa trap <br />Roof drains <br />Olher _ <br />_ Electric _ Gas _ Other I � �, <br />N0. I TYPE OF FIXTURE OR ITEM <br />A�C — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhausl tan <br />Haat pump <br />Unit heater <br />Boilpr <br />Refrigeralion <br />Woodstovo <br />Other <br />CI1' OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify lhat I have read and examined lhis application and know the same to be truo and correct. All provisions oi laws and <br />ordinaces governing th�s type of work will be complied wilh whethor specified herein or nol. The granling of a permil does not presume <br />lo c�ivo authoriry lo violate or cancel the provision of any other state or local la�a rey:dating consWctlon or the pedormance of <br />wnstruction. That I am aulhoriz�d by lhe owner o( this proporty to perform lF�e work for rh�ch applicaUon is made and 1 comply wilh lhe <br />State Contractors Law i8.27 RC' and 296200 WAC. <br />�„�� _ � �.__�.�- 1�,��; �zG ���� <br />.__ .��o.,��... �..� e ..� Date <br />