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� PERMIY APPLICATlON <br />�� <br />CITY OF E`✓ERETT 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 6 AM TO 4 PM - DEBIT 8 CREDIT CAR�S ARE �OT ACCEPTED <br />SITE ADDRESS <br />l0T NO. <br />�LOCK � I �TAACT <br />PARCEL TAX I.D. # <br />PERMIT # <br />�' �a�/ - <br />� n� Y�l1-i- �l�l� L��e�� 1I �'l1lv\\ I,�Y � Cu� `'�k��NE <br />TENANTNAME CONTACTFORPERMIT <br />-� - ��1 r �1,1-1� I C'�� )vl�-l' ` � � l�� � � -1 � �l- �r�` "Z C� _ <br />CONTRACTOR <br />�.�-,,ctr�--� ecY, <br />CONTR. LICENSE C , _ <br />USE OF BUILDING <br />WORK �ESCRIPTION <br />ADDRE55 CITYlZIP Pf{ONE <br />G1��-\��c� 331�����t1-h �ce�� C_rcle�����c� i <br />NO. I NPE OF FIXTUR[ OR REM <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop.'etc.) <br />BackBow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease Uap <br />Roof drains <br />Olher <br />HEATSOURCE <br />�Eleclric _ Gas _ Olher <br />I:Li71 <br />� <br />CONTRACT PRICE OF WORK <br />�� <br />TYPE OF FIXTURE OR ITEM <br />A1C —air handling unils <br />Forced air syslems <br />Gas piping <br />Water healer <br />Gasfreplace <br />Gasrange <br />Clolhes dryer <br />Rangehood <br />Exhaust fan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CfTY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />I hereby ceritify that I have read and ezamined Ihis application and know ihe same lo be irue and cortect. ilil provisions ot laws and <br />ordinaces governing this type cf work will he complied wi[h whelher spocified herein a nol. The granting of a pertnil does nol presume <br />to give authority to violale or cancel Ihe provision of any other state or local Iaw regulating consWcGon or lhe perfortnance of <br />con� lr�clion. That I am aulhoAzad by lhe owner of Ihis property lo periortn lhe work for which application is made and I comply with the <br />c�5'a r....�,-����.< � aw tR27 RCW and 296.20U WAC. <br />���, � <br />� <br />