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� - <br />PE,ZMIT APPLICATIO�J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425 2 <br />- 57-8810 - FAX 425-257-8857 - www.everettwa.org <br />���� �i �ao-oy <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DE81T & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADD�2ES� 7 <br />TJ � /�� r� � ,�/ <br />LOT N0. I BLOCK I TRACT <br />DESC. <br />OWNER <br />G��/� <br />TENANTNAME <br />CONTRACTOR��/PS ��,i/� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />0 <br />PARCEL TAX I.D. !� <br />CONTACTFOR <br />�.C/yi3 ADDftESS CITY2IP <br />�`��� L�i� � h"1 1�l GL'-i^C �i..P.�z�T� <br />/�s��j s'gL�I <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />� Bathtub <br />Lavatory (wash basin) <br />Shower <br />L Kitchen sink 8 disposal <br />Dishwasher <br />� Clothes washer <br />Laundry tray <br />Sink (service/badmopletc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Roof drains <br />Other <br />HEATSOURCE <br />Electric Gas Other <br />P R IT# <br />PHONE <br />zS� �'� z_ � <br />PHONE <br />PHONE <br />�S j�- Z j gjC� <br />CONTRACT PRICE OF WORK <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air hardling units <br />Forced air systems <br />Gas pipiny <br />Water heater <br />Gas fireplaco <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstova <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby cerilify that I have read and examined this applicaticn and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this rype of work will be complied with whather specified herein or not. The granting of a permit does n�t presume <br />to give autherity to violate or ca��ce! the provision of any other siate or local law regulating cons�ruction or the performance of <br />construction. That I am authorir_ed by lhe 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 RCW and 296.200 WAC. <br />� /� <br />. / � ,- s*�( /:.�'' � `r�y.�� -= C� .�� i_! �-C� � <br />/ <br />