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P�RMI'T APPLICATIGnI <br />CITY OF EVERETT PERMIT SERVICES <br />?200 CEDAF� STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-885? - :��ti.everettwa.org <br />APPLICiaTlONS AR.� ACCEPTED FROM 8 AM TO 4 P�;1 - DEBIT & CREDII' CARDS ARF NOT ACCEPTED <br />SI7E ADDRESS <br />% � �- ; q L� <br />LEGA LOT NO. <br />DESC. <br />1S i I � N <br />TENANTNAME <br />PARCEL TAX I.D, il <br />BLOCK � TRACT <br />j �� y %'i'; <br />ICONTACT FOR PERMIT <br />CONTRAC7tlR (� (/,� �,(, �j �-TG� '-�!"G'�a� ADDRESS <br />CONTR. LICENSE #_ y 1 bI � Y <br />L' LC� �ti C� i'1 4c m%��..�/i <br />USE OF BUILDING <br />WORK DESCRIPTION <br />�l.,�l'.i,W � ��I��� `L <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Dathtub <br />Lavalory (wasli basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />IPERMIT A <br />BoSd�l-D3 � <br />YIZIP PHONE <br />�'c/, u-`�-S-S��I-153� <br />PHONE <br />CITY2IP PHONE <br />3,"�z�hv•s �= ev� �1�7s�-,5'�i-Is3 / <br />HEA7SOURCE <br />Electric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />�,. <br />� � ,,r0 0 <br />NO. � NPE OF FIXTURE OR ITEM <br />AIG - air handling unilc <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Ranc�o hood <br />Exhaust fan <br />Heal pump <br />Unit healer <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETf LOCAL SALES 7AX CODE IS 9105 <br />I hereby ceritify thal I have read and examined lhis application and know the same to be true and correcL Att provisions of laws a�d <br />ordinaces goveming lhis type of work will be complied �vith whe;her specified herein or not The granling of a permil does not presume <br />to c�ive authonry lo violale or cancel the provision of any other stale or local law regulating construction or the perfortnance of <br />conslruaion. That I am aulhorized by the owner of this property to perform the work (or which application is made and I comply with lhe <br />State Contr�clors Law�ttf�27 F3eW and 296.200 WAC. <br />