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;' � <br />SITE ADDRESS <br />DESC. <br />PERMIT APPLICATION <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 <br />PARCeL TAX I.D. # <br />LOT NO. � BLOCK I TRACT OR SUBDIVISION Y. <br />L � � � �- � `� C,' � ��.' i � <br />TENANTNAME � CONTACTFOR <br />CONTRACTOR/l���S S(����� fJ�,I�j�DRESS i���x �� � / <br />.(% � y <br />CONTR. LICENSE it <br />f�7`}��CS :'��/�•� `� . <br />USE OF BUILDING <br />WORK DESCRIPTION <br />lL <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />� Ba1hWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />� Clothes washer <br />L Waterheater <br />Sink (service!bar/mop/elc.) <br />Backtlow pr� ���nter <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />011ier <br />HEATSOURCE <br />�N�`"y,--. <br />Eleclric Gas Other <br />CITY2IP <br />�1/1 iJ��N <br />cl�rf— <br />'ii ���? / <br />�� - a3 -07 <br />RMIT # <br />��` -i> <br />�/'��4- <br />PHONE <br />PHONE <br />l-.�/Z-y 'iS� <br />�G � � <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas (ireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Heatpump <br />Unit heater <br />Bailer <br />Refrigeralion <br />Woodslove <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correcl. All provisions of laws and <br />ordinaces goveming lhis lype of work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />to give authorily lo violate or cancel lhe provision of any other slale or local law re�ulaling construction or lhe pedormance of <br />conslruclion. That I am authorized 6y the ov.�ner o( this property lo perform lhe work for which application is made and I compty with the <br />State Conlraclors Law 1827 RCW �nd 296.200 WAC. <br />�) r <br />: ,. � � _ � � �� �— <br />,' � % �Yi :�'�:F-�-�' . <br />