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P�.�MIT AP�'LICATIO�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org j a� �S•O�-� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />`��Z7 a <br />LEGA LOT N0. <br />DESC. <br />OWNER <br />� �a�� l�ra��.t'� <br />TENANT NAM� <br />CONTRACTOR ��� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />/�25��G'��a, � <br />WORK DESCRIPTION <br />.� <br />BLOCK <br />i PS, LL! <br />PARCEL TIUC I.D. # � � PERMIT # <br />TRACT <br />07 e�lE ���s'� P/� <br />CONTACl� FOR PERMIT <br />�i'�/� zct rl �'i <br />or 0 �clY� ,�- <br />NO. I 1YPE OF FIXTURF OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />HEATSOURCE <br />_ _ Electric <br />Other <br />d3 <br />PHONE <br />20� 790 i�6�3 <br />CITY2IP PHONE <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 Z <br />Gas fireplace � <br />Gas range <br />Clothes dryur <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woadstove <br />Uther <br />CITY OF EVERETT LOCAL SALES 7AX CO�E IS 3105 <br />I hereby cerilify that I have read and examined lhis application and know the same to be lrue and correct. All provisions o` Iaws and <br />ordinaces goveming 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 violale or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for �vhich application is made and I comply with the <br />State Contr�Gqrs Law 18.27 RCW and 296.200 WAC. . , <br />