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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 — vwvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />LvC� � L_:� <br />LEGAL LOT NO. BLOCK <br />DESC. <br />OWNER <br />S7 <br />n �c-e.c� � <br />TENANT N ME <br />CONTRAC"iUR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />PARCEL TAX I.D. # <br />TRACT <br />ICONTACT FOR PERMIT <br />AD RESS <br />�ol.P�t `5 �� f S <br />WORK DESCRIPTION <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhtub <br />lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposai <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbar/mop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />HEATSOURCE <br />Electric Gas Olher <br />I � MIT A� <br />S�� -.Z <br />CITY2IP PHONE <br />�l�:s 5s� 3.3v�/ <br />� PHONE <br />CITY2IP PHONE <br />� CONTRACT PRICE OF WORK <br />NO. I NPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air;;ystems <br />� Gas piping <br />Water heatar <br />� Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />cxhaustian <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby ceritify that I have read and examined this application and know lhe same to be true and correcl. All provisions of laws and <br />ordinaces 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 violato or cancel the provision of any other state or local law regulating construction or the pedormance of <br />construction. Thal I am authorized by �he owner ot ln's property to perform lhe work for which application is made and I comply wilh lhe <br />State Conlractors Law 18.27 RCW and 296.200 WAC. <br />SignaWre of OwnedConlrector/AulhorizeA Agent Dale <br />