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P�RMIT APPLICATIVN <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 <br />SITE ADDRESS <br />�, �i' U `i. �� � � �� � <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />OWNER / ADDRE <br />�L ��-�J, � �Sv ; J <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />�� r�1 r.7 <br />PARCEL 7AX I.D. # <br />CONTACT FOR PERMIT <br />ADDRESS <br />HEATSOURCE <br />Electric Gas <br />c� � w�.�..�- <br />NO. I TYPE OF FIXTURE OR ITEM <br />Tailet <br />Bathtub <br />Lavatory (wash basin} <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. <br />PERMIT N <br />�._«..o� - <br />PHONE <br />C�TY21P PHONE <br />CONTRACT PRICE OF WORK <br />Other <br />TYPE OF FI7(TURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3f 05 <br />I hereby ceriti(y that I have read and examined this application and know lhe same to be true and correct. AII provisions of laws and <br />ordinaces goveming lhis lype of work will be complied wilh whelher specified herein or not. The granting ot a permit does not presume <br />lo give authority to vioiale or cancei the provision of any other slale or local law regulaGng conslruclion or the perfortnance of <br />construction. That I am aulhorized by the owner of ihis property to perform the work for which application is made and I comply with the <br />Stale Contractors Law 18.27 RCW and 296.200 WAC. <br />