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ry <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 — FAX 425-257-8657 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM % F, ,„� <br />_ � <br />S1TE ADDRESS PARCEL TAX I.D. # PERMIT # <br />__�fR S Ev�fe ffrlc�ll t�Jvl � So�o3 —(�Ai <br />�� � �, <br />YENANTNAME <br />CONTRACTOR <br />BLOCK <br />���'�'.� �Je_c�h 5•�q4,S <br />TRACT <br />CONTACT FOR PERMIT <br />CONTR.UCENSE# ;?„�,J,� �G J <br />VC= 7 �L� <br />USE OF BUILDING <br />� �t�Yc�n� L <br />I_.Je�'z� 1n/f�cirraia <br />7%�v i-rclJ�i,1ES'J n lQ(. <br />HEAT SOURCE I <br />_ Eloctric _ Gas _ Olher <br />WORK DESCRIPTION <br />--�'�S� l l (� j L�.b',�n.: "f"" S� c�'h <br />N0. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishweshar <br />Ciothes washer <br />Laundry Vay <br />Sink (service/badmop/etc.) <br />BackFlow prevenler <br />Urinal <br />Drinking Fountein <br />Floor draln <br />Grease trap <br />Roof drains <br />Other <br />�' //4•^LS�YS� <br />PHONE <br />�as -���,-�� <br />PRICE UF WORK <br />N0. � TYPE OF FIXTURE OR ITEM <br />AIC — aIr handling units <br />Forced air systems <br />Gas plping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhausttan <br />Heat pump <br />Unit heater <br />Boiier <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCqL SALES TA% COUE 13 9706 <br />I hereby ceritity that I have read end examined lhis application and know the seme to be true and correct. All provisions of laws and <br />ordinaces govem(ng this type of work will be complied with whether specified herein or not. The granting of a pertnit does not presume <br />to give autho7ty to violate ar cancel the provis(on of any other state or local law regulating construction or lhe perfortnance of <br />conslruction.l'hat I am authorized by the owner of this property to perform the work `�r which application is made and I comply with the <br />State Contractors Law 1827 RCW and 296.200 WAC. <br />O G• <br />