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P�RMIT APPLICATII.N <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 />SITE ADDRESS <br />�LEGA LOT NO. <br />T� AN�N ME ~� �� � <br />S �..I � <br />CONTRACTOR SL, 1 � <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />rLr���o.II Cer,-I��al <br />TRACT <br />PARCEL TAX I.D. # <br />/ �j �� U.� o �� 4 <br />�1 �.� .� �_ <br />ICONTACT FOR PERMIT <br />ADDRESS <br />HEATSOURCE <br />_ Eleclric � Gas _ Other <br />,� ��� r�-iitnlA .2.5:� - �..I 3 <br />PHONE <br />CITY/ZIP PHONE <br />I CnNTRACT PRICE OF WORK <br />i�i�a�i��t��� Sys�eiti���'�as-1��re��ae�..-�n5�r� <br />� -- ---- -- <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shawer <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etcJ <br />BackOow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling unils <br />Forced air systems <br />Gas pipin� <br />Water heater <br />�_ Gas fireplace <br />Gas ranpe <br />Clolhes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boi�er <br />Refrigeretion <br />Woodstove <br />Other <br />CITY OF EVL'RETT 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. AII provisions of laws and <br />ordinaces governing this type of work will be complied wilh whelher specified herein or not. The granling of a permit does not presume <br />lo c�ive authoriry lo violale or cancel lhe provision of any olher stale or local law regulating consWction or lhe perfortnance of <br />conslruction. That I am authorized by lhe owner of this property to perform the work for which application is made and I compiy with the <br />State Conlractors Law 18.27 St��W and 296.200 WAC. <br />_/_Q <br />