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F-ERM9T �►�PLICAT�JN <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 />APPLICATIONS ARE ACCC-PTED FROM 8 AM TO 4 PM - DE81T & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS I PARCEL TN( I.D. # PERMIZ�/.� -�/ <br />� ) � �/ <br />�c•(va.'.� ��,�.:nJls-� ��J�i br531lenOoolfaC�1 /�J�- � <br />LOT NO. <br />E <br />TRACT <br />��G \4� <br />3 "Z "'> >�"' F�' rL <br />CONTACT FOR PERMIT <br />�.�1� ��Z� �`�31 ��1� <br />PHcrie <br />CON RACTOR_ � ADORESS -tv, CITY2IP PHONE <br />I�datR- �r�l-�-(��2.���s�L�C ��o3a-3S R�.�S� �3�1+.�AS_ �l,ia'-1�F3-�1�4 <br />CONTR. LICENSE # <br />(� �1415 iZ L �0 3 a�.� _ — <br />USE OF BUILDING <br />i.�tr�rto �So iic..aa 1Qs.�,.� <br />�j-6A P• f�� <br />WORK DESCRIPTION <br />� <br />HEATSOURCE <br />Electric Gas <br />Other <br />� <br />�;u•i,,,c, <+� �Viyi�:-J-�a �. L,�a��-��.��A ,_' a.�c:,q,�l <br />�.1 <br />PLU <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash 6asin) <br />Shower <br />Kitchen sink 8 disposal <br />Oishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar'mopletc.) <br />Backflow preve:rier <br />Urinal <br />Dnnking Focntain <br />Floor drain <br />Grease trap <br />Raof dr:,ins <br />Other <br />CONTRACT PRI�E OF WORK <br />NO. I TYPE OF FIXTU(2E OR ITcM <br />A/C - air handling unils <br />Forced air systems <br />Gas piping <br />W ater heater <br />Gas flreplace <br />Gas range <br />Ctothes dryer <br />Range hcotl <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CI il' OF EVEFETT LOCAL SALES TAX CODE IS 3105 <br />I hereh,y ceriti(y that I have read and examined inis appiicalion and know the same to be true and correct. All provisions of laws and <br />ortlin3ces governing this type of work will be comolied +vith whether specifed nerein or not. The granting of a permit does not presume <br />�0 9've authonry to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />cocstruction. That I am authorized by tne owner of thi; property to perform the work for which application is nade and I comply with the <br />Slate Contractors Law tB.27 RCW and 206.200 WAC. <br />1— <br />, <br />