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P�RMiT APPLICATIuN <br />CITY AF EVERETT PERMIT SERV[CES <br />3200 CEJAR STREET, EVERE'i7, WA 98201 <br />425-257-£�810 — FAX 425-257-8857 — www.everettwa.org <br />Se� i 3 7Wr°a�'R6 �� y� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CRFDIT CARDS ARE NOT ACC[PTED <br />LOT <br />DESC. <br />TRaCT <br />PARCEL TAX I.D. # <br />�� <br />l.hctiw.�o�- C.o,rno; �,�o.� �f(�No ��krz., �n.e�n �'u,.-, 1 �e/'e�i <br />TENANT NAME CONiACT FOR PGR IT PHONE <br />��su�� C��'�e �,, �Gc. I ��11 N\��,-�,r �o� �`�7aoss` <br />C6NTRACTOR ADDRESS CITY2IP PHONE <br />CO�iR. LICENSE # <br />USE OF BUIL�JING <br />WORK DESCRIPTION <br />.V <br />, �: � SOURCE <br />Eleclric _ Gas _ Other <br />f,�2�n ���� <br />N0. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop(etc.) <br />BackFlow preventer <br />_ Uriral <br />Drinking Founlain <br />Floor drain <br />^ 6rease trap <br />Roof drains \ <br />Other S�� � �-�%���\�✓ <br />E-1a�,n.� v� �� Si <br />COP;TRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />I <br />A/G — air hantlling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Cblhes dryer <br />Range hood <br />Exhaust fan <br />Heat pump ,., <br />Unitheater ��j��(_, ����l�G� <br />Boiler <br />Refrigeration <br />Woods:ove <br />i)ther _ <br />CITY OF EVERETT LOCqL SALES 7AX CODE IS 3105 <br />I hereby cerilify 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 will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulatirg consWction or the performance of <br />construction. That I am authorized by the owner of lnis property to perform the work for which application is made and I comply wilh the <br />Slate Contraclors Law �827 RCW and 296200 WAC. <br />