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F�cRMIT APF'LICATjVN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9t3201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 A�/l TO 4 PM - DEBIT $ CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />� � t <br />IEGA LOT �C. <br />DESC. <br />OWNER <br />c..e_. , <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />�S I LC( d_�7 L <br />PARCEL TAX I.D. # <br />aa- 9�afl3 <br />BLOCK TRAC7 <br />ADDRESS CITY2IP <br />I`I3da c��' �u��d �I���,�� <br />� CONTACT FOR PERMIT <br />ADDRESS CITY2IP <br />HEATSOURCE <br />_ Eiectric !/ Gas _ Other <br />WORK DESCRIPTION <br />� P lac e S�u-!�e �o a•� <br />� u v-( l a-Q cc�c,� 1-� �'v� � S <br />N0. 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 />Laundry tray <br />_ Sink (service/badmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founfain <br />Fioor drain <br />Grease trap <br />Roof drains <br />_ Other <br />� <br />NO. <br />PERMIT N <br />$o5a a-p.�3 <br />PHONE3b� ��cJ3 - <br />��vaa� 35�� <br />PHONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />L�� �,� ; ��� <br />TYPE OF FIXTURE OR ITEM <br />w� — air nandung uNts <br />Forced air systems <br />Gas piping <br />Water heater <br />Gasfireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeratfon <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 1'AX CODE IS 9105 <br />I hereby ceritify that I have read and examined this applicaGon and know the same to be true and corract. All provisions of laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or not. The granUng of a pertnit does not presume <br />to give authonty to violate or cancel the provision of any other state or local law regulating consWcdon or the performance of <br />construction. That I am authorizea by the owner of this property to perform the work forwhich appifcatlon is m2de and I comply wi.h the <br />State Contractors Law 18.27 RCW and �96.200 WAC. <br />� <br />