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^ _r�MIT APPLICATIG�J <br />�S OF EVERETT �ERMIT SERVICES <br />3200 CEDAR STR�ET, EVERETT, WA 98201 <br />_5-257-8810 — FAX 425-257-8857 - www.everettwa.org ,i �; � `,'J�- � � <br />APF <br />SITE ADL <br />�i. <br />LEGAL <br />DESC. <br />OWNER <br />TENANTNAME <br />�CCEPTED FROh1 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />BLOCK <br />PARCEL 7AX I.D. # <br />o� S y � c0000 <br />TRACT <br />ICONTACTFOR <br />RERh11T # <br />L�;,���-o r 5� <br />iJ I � <br />1"2oz—Al3—b <br />PHONE <br />�(n• <br />y�a• <br />CONTRACTOR ADDRESS <br />CITY2IP PHONE <br />.9rEibclr� Ho�r�esZ�tC. IOlal �'�erc��crt� Wc� 4���.rr�a.'(qb��pcJ �C(�•`l75'•4�9y'7 <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEATSOURCE <br />_ ElecMc � Gas _ Other <br />WORK DESCRIPTION � � l " . i � ' ''�, , ; , ' � t � I • ; ` � <br />NO. I TYPE OF FIXTURE OR IiEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />Urinal <br />Dnnking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />N0. � TYpE OF FI%TURE OR IiEM <br />wu — air hantliing unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplaco <br />Gas ran5e <br />Clothes dryer <br />Ranc�ehood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CQDE IS ]f 05 <br />I hereby ceritify that I have read and examined this appliwtion and know the same to be true and correcL All provisions of laws and <br />ordinaces governmg this rype of work will be compliad with whether specified herein or nnt. Tho granting of a permlt does not presume <br />to r,ive authonty to violate or cancel the provision of any other state or local law regulating constructlon or the performance of <br />construction. That � am authorizad by the owner of lhis property tc perform the work (or which application is made and I comply with the <br />State Cnntrectors Law 18.27 RCW and 296.200 WAC. <br />S�gnature of OwneriContracronAuthonzed Agent Date �/a <br />