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� <br />PtRMIT APPLICATIC�N <br />" CITY OF EVERETT 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 & CREJIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />LOT NO. <br />�/`� J� <br />BLOCK TRACT <br />i <br />PARCEL TAX I.D. # <br />.... .�.. ..__"___ '.. .._. <br />.,� J �� -� <br />/'i �� /��/ /.���`'� 1� �'��r�� �iL� <br />TENANT NAME � CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS <br />r�✓�c� -SF.�d /« ,��',,�1 ��sc �S'/ <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />.C� �1�����uli�;J� <br />N0. I TYPE OF FIXTURE OR ITEM <br />Tailet <br />_� Bathtub <br />Lavatory (wash basin) <br />Shower <br />� Kitchen sink & disoosal <br />Dishwasher <br />� Clothes washer <br />Laundry tray <br />Sink (service/badmop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />_ Roof drains <br />Other <br />CITY2IP <br />i��r'"h I,�� <br />��1�3 I <br />HEATSOURCE <br />Electric Gas Other <br />N0. <br />PHONE <br />��J �55� <br />�� <br />CONTRACT PRICE OF WORK <br />IYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Ctothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refric�eration <br />Woodstove <br />CIN OF EVERErT LOCAL SALES TAX COOE IS 3'105 <br />I hereby ceritify that I have read and examined this application and know the ;ame to be. true and correct. All provisions of laws and <br />ordinaces governing this type of work �,vi�l be complied with whether specified herein or not. 'fhe grentin9 of a permit does not presume <br />to aive authonty to violate or r.ancei the provision of any other state or local law regulating construction or the performance of <br />construction. That I am autharized by the owner of this propeRy ro perform the work for which application is made and I comply with the <br />Slate Coplt,�ctors Law 18.27 RC',h' and 290.200 WAC. <br />G' -/ aiiJ`f <br />