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PtRMIT APPLICATIC,�� <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 ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. il ,P�RMIT #/, <br />7S{�� Qv�/2d✓i/L�x� �eS94�,.h,�v,_» !� S%�n - �/ <br />LOT NO. <br />DESC. <br />,!� <br />TR.4CT <br />CONTACT <br />`''✓�LI Wif. �l.C�' �%� �$% <br />PHONE <br />�C� "e � S��P - <br />CONTRACTOR ADDRESS CITY2IP PHONc <br />�A��u' ���.� e „y c.ti r <br />CONTR. LICENSE 7f <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. I NPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry trey <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Greaso trap <br />Roof drains <br />Other _ <br />HEATSOJRCE <br />_ Electdc _ Gas _ Other <br />NO. <br />C/O,NTRO.::T PRICE OF WORK <br />-x/ �-�Qa a <br />TYi'E OF FIXTURE OR �TEM <br />A/C - air hand ing unils <br />Forced air syst�ms <br />Gas piping <br />Water heater <br />Gas fireptace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhausl tan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />I hereby caritify that I have read and examined this application and know the same to be true and cortect. All provisions of laws and <br />ordinaces governiny this type of work will be complied wilh whethor specified herain or not. The granting of a permit does nol prasume <br />to �ive authority to vi late or cancel th ovision of any other stale or local law rQgulating consWctlon or the pedormance o( <br />consiruction. Tha am aulhorize y the owner of this property lo per(orm lhe work for which applicatlon is made and I comply wilh lhe <br />State Con c s Law A27 and 296.200 WAC. <br />-G� � � / `d�D� r <br />Si na e of wn tractodAuthonzed Agent � Date �/� <br />