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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 6 AM TO 4 PM <br />ADDRESS <br />JC.�J` Lv56-r-,.(���.� <br />LI LOT NC. BLOCK <br />DESC <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />° 1�/ /� �h(/�'1 1 �'ic�,'�J LL.% }'�(�Sh�� �� SFh,c <br />TENANT NAME � CONTACT FOR PERMIT <br />PHONE <br />ERMIT # <br />wn i r5ia� wn .............. _.. .. _.. . .. _.._ <br />� pin �N��,t�,�,f� ��� ��,���,hGf�'r-i,,,�. �.� ���-� ��2P C <br />t<� r <br />CONTR. LICENSE # �%2,f-0 %C - <br />USE OF BUILDING <br />WORK DESCRIPTION <br />HEA7 SOURCE <br />Eleclric Gas Other <br />� ;��� ��s(� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhiub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes �vasher <br />Waler healer <br />Sink (servicelbar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrep <br />Roof drains <br />Other _ <br />h�s� <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Wcoastove <br />CITY OF EVEREIT LOCAL SALES TAX CODE IS 9105 <br />I hereby ceriti(y lhat i have read and examined lhis application and know the same lo be true and correcl. All provisions of laws and <br />ordinaces goveming this type of �vork will be complied with whether specified herein or nol. The granting of a permil does not presu�i�n <br />lo give authoriry to violate or cancel the provision o( any olher slate or local law regulating wnsWction or the per(urmance of <br />construclion. That I am authorized by the owner of this property to perform the work for which applicalion is made and I comply wilh the <br />Stale Conlraclors Law 18.27 RCW and 296.200 WAC. <br />����2._--�� �/--� 9�u7 <br />2 <br />