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PERMIT APPLICATIUN <br />CITY OF EVEREfT PERMfT SERViC _� �`� �� <br />3200 CEDAR STREET, EVERETT, `�NA 9II201 <br />42�-257-881 U- FAX 425-257-8857 - www.everettwa.ora <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADURESS <br />��� �� C fF�� y (- �F v-� <br />DESC. <br />� ..,'EL TAX I.D. # <br />BLOCK I TRACT OR SUODIVISION # <br />.-�- J�l� � ( �^ � Ll cH � _n (� <br />TEPJANT NAME <br />�It„•'c f�c�F �v-� <br />CONTACT FOR PERMIT <br />PrE�RMIT # <br />b�+�CL <br />,t �t .-c F�-- �-/Z� -355 -785G <br />PHONE <br />! E•MAIL <br />CONTRACTORI ADDRESS CITY/ZIP PHONE <br />`,..i. l i N.c r G U i 1-O ��. �.kj t'..c s G I L�j �. O L L"� I. .V. __ �-/' 1 i N�I �v .� Cr� ".' G 3 � <br />CONTR. LICENSE il � I'"� + I ��� / <br />CG�LJ 8�N 9ra c_� ' � � Y=�= �a� --�o�;� <br />USE OF 6UIL6ING fiEAT SOURCE CQNTRACT PRICE OF WORK <br />! <br />�,�µ: � �u ^ � y _ Electric _Gas __ Olher � G �G-S. o O <br />WORK DESCRIPTION � <br />�c - rc�• d� 5, 3�lG <br />Nf�. I TYPE OF FIXTUFE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />�ishwasher <br />Clothes washer <br />Water healer <br />Sink (service/barlmop/etc.) <br />Backliow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Other <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Waler healer <br />Gas tireplace <br />Gas range <br />Cloihes dryer <br />Ran�e hood <br />Exhausl (an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodsiove <br />CITY OF EVER5TT IOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y thal I have read and ezamined this application and know the same to be lrue and correct. All provisions of laws and <br />ordinaces governing this lype u( work will be complied wilh whelher specified herein or noL The granting of a permil does not presume <br />lo give aulhorify to violate or cancel lhe provision o( any other slate or local law regulatina constr�clion or the performance of <br />conslrur,lion. Thal I am aulhorized by Ihe owner of this property to perform the work tor which applicalion is made and I compty wilh the <br />Slale Contraclors Law 18.27 RCW end 296.200 WAC. <br />�'✓ C--�_ V -2p'-US <br />��___..__'r.._._'"'..__'"_"'_�n..��.,..:_.,a n,...... n.,�� <br />