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PE�tMIT APPLICATIO�� <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 - DEBIT & CREDIT CARDS ARE NOT AC�EPTED <br />SI'; E ADDRESS <br />la `�� 25 L�u,)P,v 12 � <br />LEGA LOT NO. <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIP710N ,�� <br />'i� V12 w <br />, r � <br />BLOCK I TRACT <br />PARCEL TAX I.D. # <br />��. <br />CON'iACT FOR PERMIT <br />L.e.s ILc� %z <br />ADDRESS <br />HEATSOURCE <br />Electric Ga:[ Olher <br />�nn 2,.J � t�,s � t�.P -1 <br />��ee 5��.,,, : <br />�' <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Sh�wer <br />Kitchen sink & disposai <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drein <br />Grease trap <br />Roof drains <br />Other <br /># <br />PHONE <br />�ris-��v-�3 s� <br />CITY2IP PHONE <br />CONTRACT PRICE OF WORK <br />C1<<S{'w� S-�xLJ Ou� <br />� �� 5 -��e , <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas flrepiaca <br />Gas ranga <br />Ciothes dryer <br />Rangehood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3�05 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of Iaws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any olher state or local law regulating con;truction nr the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law �8.27 RCW and 296.200 WAC. <br />�V��O^� � • <br />