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SITE NDDRESS <br />��d� <br />PcRIVIIT APPLICATII�N <br />CITY UF EVERETT F'ERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-tS857 - www.everettwa.org <br />� <br />APPLICi�TIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PAFCEL TAX I.D. # <br />BLQCK I Tr2ACT OR SUB�IVISION # <br />PERMIT # <br />Bv`7nv - <br />� OWNER AUURE55 �.�ivur rnvr.c <br />� ��Fr-�,y 7�� F� �-o% <br />ITENAN NT�AME CON7aCTFORFtRM1T PHONE <br />� E-MAIL <br />CONTRACTOR ADDRESS �ZIP PHONE <br />� f � ' /' <br />� CONTR. LICENSE # ] l � � �.� [;. � —� � � <br />USE OF BUILDING <br />WORK DESCRIPTION <br />N0. I TYPE OF FIXTURE OR ITEM <br />i oilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen si�ik & disposal <br />Dishwasher <br />Clothes washer <br />Waler healer <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEATSOURCE <br />Electric Gas <br />NO. <br />Other <br />CQNTRACT PR10E OF WORK <br />TYPE UF FIXTURE OR ITEM <br />fVC — air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas (ireplace <br />Gas range <br />Clolhes dryer <br />Ranpe hood <br />Exhaust fan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />Ci1Y OF EVERcTT LOCAL SALES TA% CO�E IS 3105 <br />� <br />I hereby ceriti(y lhat I have read and examined lhis application and 4,now the same to be true and r,onecL All pre��isions of laws and <br />ordinaces governinc� this typc of �vork will be complied wilh �t•hether specified herein or nol. The granGnc� ot a permit does not presume <br />to yive aulhorily to violale or cancel the provision of any olher sta'e or local law regulati,iy wnsiruction or tho peAormance o( <br />construction. Thal I am aulhorized by lhe owner of Ihis propeAy lo peAorr�i the worA for which applicaticn is made and I comply with the <br />State Contraclor�L,�v 1$.2-7�RCW and 296.200 WAC. <br />.7�t_ G <br />