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�-�I�MIT APPLICATI�,N <br />CITY OF EVERETT PEr�MIT SER'�/ICES <br />3200 CEDAR Sl'REET, EVERETT, WA 98201 9 /,� ���l I�� <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.or /!(.� U/ <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & �R�DIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />63?C� �I�� <br />LEGA LOT NO. <br />DESC. 2 <br />TFNAN7NAME <br />CONTRACTOR � �;�� fN <br />CONTR. LICENSE # <br />USE OF BUILDING <br />S <br />WORK DESCRIPTION <br />PARCEL TAX : �. tF <br />�9��Qo s3a! <br />BLOCK TRACT � <br />y <br />AD ESS CITY2IP <br />j�(O z-4 �-1 �+ Aw. W� APt., �i'.. <br />CONTACT FOR PE IT <br />Mt��t ��.n�J o- �--. <br />�( ADDRESS CITY2IP <br />5 q�..W_i <br />HEATSOURC� <br />_ ElecVic �1, Gas Other <br />'3LP � <br />NO. � 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 />Laundry Vay <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drein <br />Grease trap <br />Roof drains <br />Other <br />PHONE <br />)S 3Si ' /9Sb <br />PHONE <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FOCTURE OR ITEM <br />A/C — afr handling units <br />Forced air systems <br />Gas pip(ng <br />Water heater <br />Gas flroplace <br />Gas renge <br />Clathea dryer <br />Range hood <br />Exhauatfan <br />Heat pump <br />Unit heater <br />8oiler <br />Refige2tlon <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3103 <br />I hereby ceritlfy that I have read and axamined this appliradon and know the same tu :e true and cortect All provisions of laws and <br />ordinaces goveming this type of work will be complied wilh whether specified herein or not The grantlng of a pertn(t does not presume <br />to give authoriry to violate or cancel the pravision of any other state or local law regulatlng consUuctlon or the perfartnance of <br />construction. That I am authorized by the owner of this property to pertortn the work for which applicaUon is made and I comply with the <br />State ConVagjors Law ���96.200 WAC._ <br />�IL <br />.S�t�Glo Z8S <br />