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SITE ADDRESS <br />,. _ _.. � <br />LOT <br />TENANTNAME <br />P�RMIT APPLICATI(�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDP.R STREET, EVERETi, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />TAX I.D. # ,r, <br />� O���C� L' � <br />TRACT OR <br />CONTACT FOR PERMIT <br />PHONE <br />� 6Y3 <br />O�j/,��' � E-MAIL <br />ONTRACTOR �� ADDRESS CINIZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION , <br />.,�,s/c�-�- o� / �° /`i /�i2e� <br />NO. I TYPE OF FIXTt1RE OR ITEM <br />Toilet <br />Balhtub <br />lavatury (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />Backflow prevenler <br />Urinal <br />Dririking Founlain <br />Floor drain <br />Grease Irap <br />Roof drains <br />Other __ <br />HEATSOURCE <br />,x Eleclric _ Gas _ Other <br />C4NTrZACT PRICE OF WORK <br />� �'y�� z 6�-f`ti.s� y ,�Jy� !.�-�2 <br />NU. <br />TYFe OF FIXTURE OR ITEM <br />A/C — air handlinc� units <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas (ireplace <br />Gas range <br />Clothes op�er <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil healer <br />Boiler <br />Rofrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify thal 1 have read and examined this application and know lhe same W be lrue and correct. All provisions of laws and <br />ordinacas governing Ihis type o( wo�k will be complied with whether specified herein or nol. The c�ranting of a permil does nol presume <br />lo give aulhority to violalo or cancel Uie provision of any other stale or local law regulating construction or the performance o( <br />consiruclion. Thal I am ulhorized by lhe owner of lhis property lo per(orm lhe work for which applicalion is made and I comply with the <br />Sfate Coglractors La�y/�.27 RCW and 296.200 WAC. , <br />