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i <br />PERMiT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR S7REFT, EVEf2ETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />AFPLICQTIONS ARE ACCEPTED FROM 8 AM TO 4 PA7 <br />SITEA� ES/ <br />S �G!i % <br />LEGAL LOT NO. �BLOCK <br />DESC. <br />OWNER <br />`��;�� t��s� <br />TENANTNAME <br />PARCEL TAX I.D. # <br />TRACT OR SUflDIVISION ri <br />/a�<>�o�,-r <br />CON7ACT FOR PERINIi <br />PHONE <br />--3i_D�' <br />'0�� <br />� E-MAIL <br />TR CTOR ADDRES iTYIZIP PHON <br />/_%i?v�'s 5c'.,r'✓�lL �'�/�rrr3_ �x 6-5�—/ �A.�.��.v �/� ,F}/z� <br />CONTR. LICENSE # 3�-- 4_ / � �+ �j <br />,���SS/�//��� /.5 � � � i <br />USE OF BUILDING <br />WORK DESCRIPTION <br />I� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavalory (wash hasin) <br />/ Shower <br />Kitchen sink & disposal <br />Dishwasher <br />� Clothes washer <br />� Water heater <br />Sink (servicelbadmop/etc.) <br />Back(low preventer <br />Urinai <br />Drinking Fountain <br />Floor drain <br />_ Greaselrap <br />—I Roof dr2ins <br />Other <br />HEATSOURCE <br />Eleclric � Gas _ Olher <br />iP2 <br />CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />NC — air handling units <br />Forced aii systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas rang� <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigerelion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE iS 7105 <br />I hereby ceritify that 1 have read and examined this appiicalion and know the same to be lrue and correcL All provisions of �aws and <br />ordinaces governing this type of work will be complied with whether specified I;erein or noL The granting ot a pennit does not presume <br />to give autherity lo violale or cancet lhc provision of any olher state or local law regulating construction or the performance of <br />consiruclion. That I am aulhorized by the owner of P• s pmperty lo perform the work fo: which application is made and I comply with Ihe <br />Slate Contraclors Law 1d27 RCW and 2J6.200 WAC. <br />