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'� PERMIT ,�PPL_iCATION
<br />, CITY OF EVERETT PEn^MIT SERVICES
<br />3200 CEDAR STRF.ET, EVEI�ETT. WA 98201
<br />I 425-25?-8810 — FAX 425-257-8857 — www.evereitwa.org
<br />SITE ADDRESS
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<br />LEGALI LOT NO.
<br />APPLICA710NS ARE ACCEPTEC FROM 8 AM TO 4 PM
<br />I PARCEL TAX 1.�. # � ,
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<br />BLO�K `TRACT
<br />DESG� I I - I ,
<br />OWNEF ADURESS CITYIZIP PHONE ``C�-� -`_�( ii'.�L�
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<br />TENANTNAME CONTACTFORPERMIT PHONE
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<br />1� �-'�;�_( v�;•�,C.�' ;i� - �� �^J����`���; ��r,�,-�. �'_'� �IC. 7 i'0�.�
<br />CONTRACTOR ADDRESS CITYIZIP PHONE
<br />CONTR. LICENSE #
<br />C��G OF DUILDRJG
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<br />HEATSOURCE
<br />� Electric _ Gas _ Other
<br />WORK DESGRIPTION -�'� `(y-i�- �j , �— . � �>j��,
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<br />PLUMBING �, _ � �('t f;
<br />N0. I — TYPE OF FIXTURE OR ITEM " l`*.., �; 1
<br />_ Tailet
<br />Bathtub
<br />I.avatory (wash ba<in)
<br />Shower
<br />Kitchen sink & disposal
<br />Dishwasher
<br />Clothes washer
<br />Laundry tray
<br />Sink (service!badmop/etc. )
<br />Back(low preventer
<br />Urinal
<br />Drinking Founiain
<br />Floor drain
<br />Grease trap
<br />Roof drains
<br />Olher
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<br />CONTRACT PRICE OF WORK �
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<br />�_s,��� y_��C.Y C�rc>r'�
<br />MtGFiAIVtI:AL
<br />NO. I TVPE OF FIXTURE OR ITEM
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<br />AIC - alr handling units
<br />Forced air systems
<br />Gas piping
<br />Waler heater
<br />Gas fireplace
<br />Gas renge
<br />Cloihes dryer
<br />Range hood
<br />Exhaost fan
<br />Heat pump
<br />Unit healer
<br />Boiler
<br />Refngeralion
<br />Woodstove
<br />CIN OF EVERETT LOCAL SALES TAX CODE IS 5705
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<br />I hereby ceritify ihat I have read and examined this application and know the same to be true and correcl AII provisions oF laws and
<br />urdinaces govemin9 lhis type uf work �,vill be complied with whether specifed herein or not The granting of a oermit does not presume
<br />to give authority to violate or cancel lhe provision cf any other state or local law reyulating conshuction or ihe perforrr�ance of
<br />constructiqn. That I am authorized by �he owner of this property ?o perform ihe work for which applicalion is made and I compty wilh the
<br />State Conitactors Law 1827 RCW and 296.200 WAC.
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