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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 />SITE ADDR[SS <br />f= �y Lo c� s <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />BLOCK <br />�/odsiN� A�rr��,�-�n/ <br />PARCEL TAX I.D. # <br />5�9z - �o�- DDO -DOD � <br />TRACT OR SUBDIVISION # <br />�v� <br />�/ �-�a-�' �� <br />ERMIT # <br />� u/ / -�33 <br />PHONE <br />�zr. so3. i�z/ <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />,�,�,�E-FF. yz� sv� E3 9 d <br />5'��� . E-MAIL <br />A R ��— <br />Fd�i�'T/ ffad�iNG f1 �/T/�oi��� <br />CONTR. LICENSE # . <br />USE OF BUILDING <br />SF.� <br />— HEAT SOURCE I CONTRACT PHice or wvKK <br />Electric `�as _ O!her ' <br />WORK DESCRIPTION ��/ f���� ��s/D��/� <br />����il�//��/�J�DE-< < <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced eir systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Renge hood <br />Exhaust Nan <br />Heat pump <br />Unit heater <br />Boiler <br />Retrigeralion <br />Waodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceRify that I have read and examined this appiication and know ihe same to be true and wrrect. All provisions of laws and <br />ordinances governing this type of work will be Complied with whether specified herein or not. The granting of a pertnit does riot presume <br />to give authority to violate or cancel the provision of any other siate or Iocai law regulating construclion or the perfortnance of <br />conslru�(ion. That I am authorized by the owner of this property to perform lhe work for which application is made and I comply with lhe <br />c���o r.,�Yradors Law 18.27 RCW and 296.200 WAC. <br />