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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT>s <br />-I - -F ,, o� 30003�0300 , ,� <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS CITYRIP PHONE <br />Ki-)r J& 11 f± 35oA (ojbJ+e-, <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />CONTRACTOR J_) � y�t�� ADDRESS � � � � CITY2IP � PHONE <br />CONTR. LICENSEN y.W0N� I 1 qlv�� NN�i?f �I li1g6�1-�c�'�t�.�'t-j/'✓2 <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />)1 I� —� <br />Electric Gas _Other <br />WORK DESCRIPTION <br />�ryau' + (-I w i <br />NO. I TYPE OF FIXTURE OR ITEM <br />NO. I 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/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />_ <br />_ <br />_ <br />_ <br />_ <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 fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />CITY OF EVERETT LOCAL SALES TAX 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 />ordinates governing this type of work will be complied with 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 regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Gontractors Law,48.27 RCW and 296.200 WAC. <br />IL /o& <br />