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PE�<MIT APPLICATIOiv <br />CITY OF EVERETT PERMIT SERVIVES <br />3200 CEGAR 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 - DEBII' & CREDIT CARDS ARE NOT ACCEPTED <br />SITE AD�RESS � PARCEL TAX I.D. # PERMIT'�j ( <br />�i/�.a � (,(�.,'�,t1 �,�s ^--� I�� C�`/ �i' " c) i0 <br />LOT NO. <br />TENANTNAME <br />�._G' n �: :. l, �i` n <br />BLOCK <br />.c�Y �_. <br />CONTRACTOR � <br />�/'c:>�/',�' SS�t <br />CONTR. LICENSE # � <br />��, ' <br />USE OF BUILDING <br />WORK DESCRIP710N <br />� <br />TRACT <br />ADDRE55 CITY2IP <br />CONTACT FOR PERMIT <br />AOORESS CITY2IP <br />O�vj <br />_ HEATSOURCE I <br />Electric Gas Other <br />�, / / A r � <br />✓ �j�GC7� <br />NO. I TYPE OF PIXTURE OR ITEM <br />i Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />i _ Dishv.asher <br />P <br />_ Clothes washer <br />_ Laundry tray <br />I_ Sink (service/bar/mop/etc.) <br />, Backflow preventer <br />, Unnal <br />i _ Drinking Fountain <br />Floor drain <br />Grease trap <br />i _ Roof drains <br />Other <br />PHONE <br />FHONE <br />CONTRACT PRICE OF NORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handlinc� units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas 'ireplace <br />_ Gas renge <br />Clothes dryer � _� /� J � <br />� Range hood �/ n� � /l <br />Exhaustfan /� <br />Heat pump r <br />Unit heater <br />_ Boiler <br />Refri9eration <br />Woodstove <br />_ Other <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work viill he complied with «hether s{�ecified herein or not. Tlie granting of a permit does not presume <br />to give authority to violate or cancel the provisicn of any othar state or local law regulating construction o; the performance of <br />construction. That I am authorized by the owner of this property to perform the work for�vhich application is made and I comply with the <br />State Contrec;ors Law 18.27 RC'N and 296.200 WAC. <br />Signa[ure of OwnedContrectoriAuthonzed Agent Date �/Z <br />