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I�ERMIIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8657 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />LOT NO. <br />DESC. <br />.y�/q y <br />BLOCK� TRACT <br />ADDRE <br />LL � Y�eux9� <br />PARCEL TAX I.D. S <br />CONTACT FOR PERMR <br />e Cd�; �ol'�nsr <br />PHONE <br />CONTRACTOR ADD ESS ''7 CIYYltlP�/ /'PHO E <br />CCONTRIJCENSEp��' -iNG, I�D �, FUI�ISrO� WIG'�ITA� 1'-�.S 13I��ZGSZSI� <br />Co�sTcB � l.31� 9 67��� <br />USE OF BUILDING <br />HEATSOURCE <br />_ Eleclric _ Gas ��Other <br />WORKDESCRIPTION T�.ERInR or-���s, M�No� <br />NO. I TYPE OF flXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains A <br />Other T <br />CONTRACT PRICE OF WORK <br />21, z31 ' <br />G, Pi��NT, CA�.P�'r <br />NO. � TYPE OF FIXTURE OR ITEM <br />Fvc — a7r nantlling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Cbthes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refigeralion <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 37 U5 <br />I hereby ceritify that I have read and examined fhis application and know the same to be true and correct. All provisions of laws and <br />ordinaces goveming lhis type of work will be complied with whether specified herein or not. The granting of a pertnft dces nol presume <br />to give authority to violate or cancel the provision of any olher slate or local law regulating construction or the performance oF <br />consWdion. That I am authorized by lhe owner of lhis property to perfortn the vrork for which application is made and I camply with the <br />Statey,�ntrdctors Law 1J�27 RCW and 296.200 WAC. <br />)ate � I•v <br />