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�� <br />PERMIT APPLICATION <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��- ad `-'I � <br />LOTNO. I BLOCK <br />DESC. <br />TENANTNAME <br />� c�� �y G <br />]NTRACTOR �. <br />�^own h�r� 1�����1c'c-t►�u�, 1��. <br />USE OF BUILDING <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />FOR PERMIT <br />�ZiJ,� /i7�// <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />WORK ESCRIPTION ,,,�kler f�c�lS <br />C11dc� CiCJ �,�� sp. <br />��l�a,-r�c ���>1 C7�� f„� sprr�,�l�� G�a�('s <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilcl <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (s?rvice/bar/mop/elc.) <br />Backtlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />,P/ERMIT� #�y <br />Y'�, ,�1 V' 1 " ��� �'I _ <br />� PHONE <br />��l (,��� �/2�'.�SS/�� /77/ . <br />P ONELI��"���I�J�/L� <br />E•MAIL �f��r"J���l ,� r�u.�n�� . c�n� <br />p ��iF ONE <br />� �Cfj %Y?52 <br />��ls �l�lllr�r% <br />ICONTRACT PRICE OF WORK <br />�' �,�l:iU- ct� <br />NO. I TYPE OF FIXTURE OR ITEh1 <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Fiange hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstave <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />- I hereby ceritify Ihat I have read and examined this application and know the same to be true and correcL All provisions of laws and <br />��, ordinaces goveming this type ol work will be complied with whether specified herein or noL The granting ot a permit does not presume <br />'�. m give authority to violate or cancel the provision of any other state or local law regulating consWction or ihe performance of <br />� cansWction. That I am authorized by the owner of this property to perform ihe work tor which application is made and I comply with the <br />Stato ntractors Law 18 R�W and 296.200 WAC. <br />, ����ll�� ��r»� z �//�/Z <br />