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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 38201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM v� j�� O� <br />SITE ADDRESS PARCEL TAX I.D. � � PERMIT It <br />�lo?� �Ornb.t.iG( �}�!� I d0`i`�SFfGI ����vo I �Vl �70"� `�, <br />LOTNO. � BLOCK � TRACTORSUBDIVISIONg <br />Ke��c� V� <br />TENAtf� NM1E <br />N1� <br />u3 /.Un���u�:( A v� <br />FOR PERMIT <br />3 �G^�� �7 �3 <br />� � / �i ' O'v p <br />W���"_ � i i j�J/� .///a��s _........ I .. r rnvnc �� <br />nnj v�� r-- r'� /�56o Jl��h�,� �c �6' i9- <br />CONTFi. UCENSE # j, i p� `� r T�sd Q� //� / i /' / G �7�_ p,J� X <br />WliJrlli- P`o?Z �o U%� v.�a ��QV S v <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />_� � � ��,�,UJ� (�,�,� � Electdc _ Gas _ Other � � Q �—� <br />WORK DESCRIPTION <br />�,Ul�.��t �,�.� I �� �. �� Gu �. ��,- <br />NO. I TYPE OF FlXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/badmoplefo.) <br />Bachflow preventer <br />Urinal <br />Drinking Founlain <br />Floor draic <br />Grease irap <br />Roof drains <br />Olher <br />NO. � TYpE OF FlXTUqE OR ITEM <br />A/C- air handling uniLs <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas timplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustlan <br />Heat pump <br />Unit healer <br />Boiler <br />RefrigeraGon <br />Woodstove <br />CITY OF EVERE7T LOCALSALES TAX CODE IS 3105 <br />� hereby ceri(ify iha� I have read and examined this applicalion and know the same to be true and correct. A�I provisions o( laws and <br />ordinaces poveming this type of work will be complied with whether speci(ied herein or noL The granting ot a pertnit does not presume <br />to give aulhority to violate or cancef the provision o( any olher state or local law regulaling conshuction or the pertormance o( <br />construction. That I am au�horized by the owner ot ttiis properry lo per(orm the work tor which appiication is made and I cromply with the <br />Stale Conlractors law 1827 RCW and 296.20D WAC. <br />Il ' � ) <br />� I.���IU�;i�l ��1,( li-�l� G� ���Z����% <br />