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PEF2MIT APPLICATION <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 ��6 ..� '7 <br />SITE ADDRESS � PARCEL TAX I.G. # r I PERMIT # �!_ <br />LEGAL LOTNO. <br />DESC. <br />OWNER <br />���� rsi` <br />TENANTNAME <br />CONTRACTOR J' � <br />CONTR. LICENSE # <br />BLOCK T<ACT <br />ADDRESS <br />Q S c� fi` /z-j z�' - s, ���• <br />CONTACT FOR PERMIT <br />r'� /� ,( j <br />���/ ��� �` v�C4//1,/ <br />ADDRESS <br />C� �L' �1 �'� <br />USE OF BUILDING <br />o , <br />; :rCi'. .:, <br />WORK DESCRIPTION <br />/�1�/�I � <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backtlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />HEATSOURCE <br />Electric S Gas _ Other <br />CITYIZIP� / PHONE <br />JP¢'//i �' !Ul�� �C�l - I I !^ � Z/� <br />PHONE <br />CITY2IP PHONE <br />�NTRACT PRICE OF WORK <br />� �G-�''e��. <br />/ <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />� Forced air ss�slems <br />� Gas piping <br />� �_ 1'Vater heater <br />Gas fireplace <br />Gas range <br />Clo�hes dryer <br />RenyB ho0d <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Fefrigeration <br />Wuodstove <br />I Other _ <br />CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br />I hereby cerilify that I have read and examined lhis application and know the same to be lrue and correct. AII provisions of taws and <br />ordinaces governing lhis type of work will be complied wilh whether spe�cified herein or not. The granting of a permit does nol presuma <br />to give aulhority to violate or cancel the provision of any olher slate or local law regulaling construction or the performance of <br />construction. That � am aulhorized by the owner of this property to perf�xm the wor6 for which application is made and I comply with the <br />Stale Conlraclors Law 18 �7,E2CW and 296.200 WAC. <br />i <br />�,� r� ��J' c9� —:� 6� U� <br />