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SITE ADDRESS <br />LOT NO. <br />tM <br />NAME <br />PtRMIT 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 <br />PARCEL TAX I.D. # <br />TftACT <br />CONTACT FOR PERMIT <br />� <br />�'� (�a/ ' � � <br />PERMIT # <br />C �� � <br />PHOHE c�-��'��� <br />f r�/( /D�- 2 <br />PHONE <br />�il2btr`�-��� Czf f�- 0'�a�rf � . <br />CONTRACTOR ADDRESS CITY2IP PHONE izS j7 %� <br />_���� /�bnt� 5�:�lufiv.oS Z'-��z L.ti�.�fr- Gti� �o�1�z, u�� 5}�z7z � yl�s r <br />USE OF BUILDING <br />HEAT SOURCE <br />L Eleclric l�Gas Other <br />WORK DESCIRIPTION <br />�:ti20dG � � t>SG a5 �jf�+"L>.� s`�P, <br />,fr�J%G /%GLJ !<l�z�tr' :�c <br />.,� � �...,�.,, <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />✓ Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heator <br />Sink (service/badmop/elc.) <br />Backilow preventer <br />Urinal <br />Drinking Foun�ain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />/a �i9-��- ,rJ�FiL <br />CONTRACT PRICE OF WORK <br />� /�-',��iPX)�9 <br />N0. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br />I hereby ceriti(y that I have read and examined this application and know �he same to be true and correct. All provisions of laws and <br />ordinaces governing this rype of work will be complied with whelher specified herr:in or noL The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating consWction or the pedormance of <br />construction. That I am aulhorized by ihe owner of Uiis property to periorm the work for which apptication is made and I comply with the <br />Slate Contrectprs Law 18.2YHCW and 296.200 WAC. <br />`�/O.c�. <br />