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PtRMIT APPLICATIUN <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 />SITE ADDRESS <br />Low�C.c � <br />LOT NO. BLOCK <br />PARCEL TAX I.D. # <br />TRACI'OR <br />PERh11T # <br />��-�a�6 I�JI1-D�2 <br />Ltnt{�nlE .� T �%��- L vc�LL if' ri!/T 9`B�IOj `/Z.S-�.�dS��O <br />TENANT NAME CONTACT FOR PERMIT PHONE ��� �,�,`� S� ,� � <br />���E-MAIL f�/'�1^(/'���� L J�r�-. <br />CONTR. LICENSE # . <br />. � !°-1-�. <br />USE OF BUILG�NG <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Eleclric _ Gas _ Other �,� � p � ) <br />WORK DESCRIPTION 1n�� C�� i��.�-� <br />!1 <br />Cal�RA<i� � <br />i <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />Sink (service/bar/mopletc.) <br />Backflow preventer <br />Urinal <br />Drinkin9 Founlain <br />Floor drain <br />Greasc trap <br />Roof drains <br />Other <br />NO. <br />TYPE OP FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas pip?ng <br />Wafer heater <br />Gas (ireplace <br />Gasrange <br />Clolhes dryer <br />Range hood <br />Exhausl fan <br />Hec.l pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Wcodstave <br />Other <br />CITY OF [VERETT LOCAL SALES TAX COOE IS 3105 <br />I hercby cerilify lhat I have read and examined this applicalion and know the same to be true and correcL All provisions of iaws and <br />ordinaces goveming lhis type of work will be compiied wilh whether speci(ied he•ein or noL The granting of a permit does nol presume <br />to give aulhorily to violale or cancel the provision of any other stale or Iocal law regulating construction or the pedormance o( <br />wnstruction. Thal I am authorized by lhe owner of lhis property lo per�orm the work for which apphcalion is maAe and I comply with the <br />State Contracto� Law?82 CW and 296.200 Wi;C. <br />Gj � !c� <br />SignaWre o� wnedCon clor/Authorized Agent , Uale <br />��� <br />