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F�cRMIT APPLICATIuN <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 /j) —/9 � O� <br />SITE ADDRESS <br />LOT <br />CONTRACTOR �� <br />CON1R. LICENSE R <br />/_ <br />`�� i>,� PARCEL 7AX I.D. * <br />� <br />BLOCK TRACT <br />.��� y�r S��,r�-„ <br />�✓ /X'� . .��YCJ <br />ICONTACTFOR PERMIT <br />/:_Z ;l � <br />PHONE <br />�1; �. <br />!J ' .x�. <br />f/> Cc%�,,�i,.�� n:-�_� nnors�ss ,, . cmrzir <br />, ,.,�:.. �,- ,� /,'��-�„ ily" /7J,:,, ..,.;,u�. <br />,i//�`.�i�;��.� IS�,'t,C_ , ,+a.+.�%�--=,-7`� i✓/� "fYr %v <br />USE OF BU�LDING <br />WORK DESCRIPTION <br />HEAT SOURCE <br />Ek3cUic _ Cas _ Olher <br />������� 23�I� <br />NO. I TYPE OF FIXiURE OR fTEM <br />Toilat <br />Bethtub <br />Levatory (wash basin) <br />Shower <br />Kilchen sink d disposal <br />Dlsbwashor <br />i Clothes washer <br />Water haater <br />Slnk (sorvice/bar/moplutc.) <br />Backflow prevenler <br />Urinal <br />Orinking Fountaln <br />Floor drnin <br />Greaso trap <br />Rool drains <br />Othor <br />PHONE (�,�� <br />,%5C�' "{7�5i.� <br />CONTRACT PRICE OF WORK <br />��� <br />TYPE OF FlI(TURE OR ITEM <br />A/C - air handling units <br />Forced air aystems <br />Gas piping <br />Walw heator <br />Gas fireplaco <br />Gas range <br />Clothos dryor <br />Rarga hood <br />Fxhausl fan <br />Heal pump <br />Unit haater <br />Bo{ler <br />Refrigerafbn <br />wooasave <br />CfTY OF EVERETT LOCAL SALES TAX CODE IS ]tOS <br />I hereby coritity Ihal I have read and examined lhis appNcatlon and know tha same Oo be trve end cortect. All provlsbna of Iaws end <br />ordinaces govoming Ihis typa of work will be complied wilh whether spedtled herain or not The prentlnp of e pennit doea not presume <br />to give authority to Wolalo or cancel the proviabn ol any other stale ar bcal law regulatlng construdlon or tho performance o( <br />consWction. That I am aulhorfzed by tho owner of this prvperty to perlortn the work lorwhich applicatlon Is made and I mmply with tl�e <br />Stato CoMraalors Law,18.27 RCW Snd 296.200 WAC. <br />�" ; . , ' /-�L�-r <br />' �•,� �� � �; i� �„� �- <br />�� I <br />