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F�cRMIT APPLICATIuN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.urg <br />APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br />SITE ADDRESS <br />��SSO� Low-e�� 1�� <br />LOT NO. � BLCCK <br />UcSC. <br />�C� �^2 <br />TENANT NA <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION p <br />CONTACT FOR PERMIT <br />\1 <br />PHONE <br />� E•MAIL <br />COh R CTOR . � R �T'„'�P <br />2- �---► � <br />PERMIT # <br />M loea -aa <br />HONE �C�� <br />W R �%���i <br />CONTR. LICENSE # � <br />��'`--�' - <br />USE OF BUILDIiVG � I HEAT SOURCE I CONTRACT PRICE OF WORK <br />�� _ Electria _ Gas _ Other <br />WORK DCSCRIPTION /� � � ���� 1 , � / L, ��, �� ,L <br />� � tL� L 7t� c� <br />C_. J � <br />C'�.� G �-e .�� �� �'r- r�� � � t �_ <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (v+ash basin) <br />_ Shower � <br />Kitchen sink & disposal . <br />Dishwasher <br />Clothes washer <br />Waler healer <br />Sink (service/bar/m�plelc.) <br />Backtlow prevenler <br />Urinal <br />_ Drinking Fcuntain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher _ <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping • <br />Water heater � ). <br />Gas fireplace � r `T� <br />Gasrange <br />Cbthes dryer <br />Range hood <br />Exhausl fan � <br />Heat pump / /� � <br />Unil heater V <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be true and correct. AII provisions of Iaws .^.nd <br />ordinances governing this l�pe o( work will be complied wilh whether specified herein or not. The granting oi a pertnit does not presume <br />to give authori�y to violate or cancel �he provision of any olher state or local Iaw regulating conslruction or lhe performance oi <br />consiruction. That I am aufhorized by ihe owner of this property to perform the work for which application is made and I comply wilh the <br />State C ractor Law 18.27 RCW and 296.200 WAC. <br />r';l�,�� t-� ��<c� <br />