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PE��tMIT �`,�PLICATIO�d <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, N:A 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRE55 <br />� <br />� L� <br />LEGAL LOTf <br />DESC. <br />OWNER <br />TENANTNAME <br />PARCEL TAX I.D. # <br />BLOCK / I TRACT <br />CONTACT FOR f'ERMIT <br />CONTRAG�TOR ADDRESS CITY2IP <br />cvowri�',�� �vot�-tiu'� � p�o�c 12��3 m��I Cv�cc; �=� <br />CONTR �ICENSE # _ „ _ _ <br />USE OF BUILDING <br />�1-c��1• VNA�I S <br />HEATSOURCE <br />Eleclric _ Gas <br />; PERMIT # <br />PHONE <br />7 �-i&I � Zro�� <br />PHONE <br />�25��1�1 7(���/ <br />CONTRACT PRICE OF WORK <br />� <br />Olher � � � ���. �� <br />WO K DES RI TION <br />�. �S� ��'l�S 12�1�Cc�� C�S_) �--�e-v�,�ev�'�'S <br />�d ' �7J v�ri��tS <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Cbthes �vasher <br />Laundry Iray <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 />NO. <br />TYPE QF FIXTURE OR IT. EM <br />NC — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace � � <br />Gas range 1/ <br />Clathes dryer � �- <br />Range hood „ t � <br />Exhaustfan � �,V <br />Heat pump <br />Unil heater � <br />8oiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby ceritify that I have read and examined this application and know the same to be tma 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 authonty to violate or cancel the provision of any olher slate or local law regulating construcfion or the performance of <br />consWction. That I am awhorized by lhe owner of this property lo perform the work for which applicalion is made and I comply with the <br />State CORtr&ctors Law 18.2' RCW and 296.200 WAC. <br />