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�- <br />SITc <br />LOT N0. <br />T"� <br />PEi2MIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />BLOCK I TRACT OR SUBDNISION 8 <br />�D-ao-�� <br />g,��9�a�fb <br />Z(. <br />'l'K 3�t�-�s <br />TF.NC.NT NAME �� J I CONTACT FOR PERlMY PHONr��.y� .3 4 y� 5/�i <br />'•' I e-h�a� <br />� - <br />A DRE � <br />CONTR. LICENSE I! <br />USE OFBUILDING <br />WORK DESCRIPTION <br />ac��� <br />HEATSOURCE <br />_ Eleclric _ Gas _ Other <br />��(�l � �� (.,./� Q q � <br />U �� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <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 />CONTRACT PRICE OF WORK <br />N0. I TVPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined lhis 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 granling of a permit does not presume <br />to give authority to violate or cancel the provision ni any other state or local law regulating wnstruction or the periortnance of <br />construction. That I am aulhorized b� fhe owner of lhi roperty to pertorm lhe work for which application is made and I comply wilh the <br />State Coniractors Law-1827 RCW �nd 296.200 WA <br />�f _ __ , ,�� , ,z / Q-z3 ��� <br />Sig ure.oLGwrt�r onlractod uthg ed Acj t Date i/ <br />/ 3' <br />