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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-Bd57 - www•everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />LEGAL LOT NO. BLOCK /TRACT OR SUBDIVISION p <br />DESC. �•� 6'�6^�OC7 T�tfJ1891 Gi'E..��ich�IJl� On /�-- <br />I ,^� �an <br />- Dal <br />�� <br />TENANT NAME CONTACT FOR PERMIT PHONE `�,^�O � Il � <br />�� I�� Q / V <br />e-Ma� <br />CONTRACTOR ADDRE S CITY2IP PH N <br />CONTR. LICENSE # <br />USE OF B��LDING <br />HEA�URCE <br />_ Electric Gas _ Other <br />CONTRACT PRIGE OF wvrcK <br />WORKDESCRIPTION �@��On-r^O� W��eit,.��-- � �x� -�-�"' �J <br />i' <br />c�IJ M►'15 . �'' <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toile� <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clo�hes washer <br />Water heater <br />Sir.k (servicelbar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greaseliap <br />Roof drains <br />Otter <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Healpump <br />Unit heater <br />Boiler <br />Re(rigeralion <br />Waodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and e:.�mined this application and know the same to be true an;: correct. All provisions of I�ws and <br />ordinances governing this type of work will be complied with whether specified herein or noL The granting of a permil does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating wnstraction or the oedormance of <br />construction. That I am authorized by the owner of this property to pe:form the work for which appliralion is made and I comply with the <br />State Contract rs Law 18.2 �RCW, �and 296.200 WAC. ,y / <br />��?n�� �ii'� n�� n �'104��'��C�l�2G� V <br />