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PE�MIT APPLICATIO�� <br />CITY OF EVERET�' 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 ACCEPTED <br />SITE ADpRESS <br />�6 <br />LEGAL LOT N0. <br />DESC. <br />OWNER <br />��/V � � <br />TENANTNAME <br />�/ � <br />CONTRACTGR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK UESCRIPTION <br />��c'J I�-''�-%� <br />N0. I TYPE OF FIXTUR[ OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundrytrey <br />Sink (service/har/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />GrEase trap <br />Roof drains <br />Other <br />PARCEL TAX I.D. # <br />c� j�cjn� ��3ooGv <br />TRACT <br />CONTF.CT FOR <br />ADDRESS <br />FiEAT SOURCE <br />Electric Gas Qther <br />_ 3 <br />�—✓f/�/�JO�o/ 7�J'/Sy.� <br />CITY2IP PHONE <br />y'�� �'-> ��� <br />PHONE <br />CITY2IP PHONE <br />I CONTRACT PRICE OF WORK <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />vVater heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaustfan <br />Heatpenp <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y that I have read antl examined this applicalion and know lhe same to be true and correct. All provisions of laws and <br />ordinaces governing this typa of work will bc: complied with whether specified herein or not. The grenting of a pennit does noc presume <br />to give authonry to violate or cancel the pro��ision of any other state or local law regulatin� construction or the perormance ot <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 Contrac�ors Law 18.27 RC`N and 296.200 WAC. <br />� ���. c �� 'v —1 % <br />