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P�t2MIT 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 />SITE ADDRESS <br />� 2� <br />LEGA LOT NO. <br />DESC. 3 ¢ <br />OWNER <br />IiFA/iJ�3 ! . <br />TENANT NAME <br />� F�/!/r S L . I <br />CONTRACTOR <br />CONTR. UCENSE N <br />USE OF BUILDING <br />�G�✓ � �i <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry lray <br />Sink (service/bar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher — <br />PARCEL TAX I.D. X <br />TRACT <br />/7'l�Ce <br />CONTACT FOR PERMIT <br />ADDRESS <br />HEAT SOURCE <br />Electric _ Gas _ Other <br />PHONE <br />CONTRACT PRICE OF WOKrt <br />NO. I 7YPE 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 />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />Other <br />CIT' OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or not. The granUng of a permfl does nol presume <br />to give authority to violate or cancel the provision oi any other state or local law regulating constructlon or the perfortnance of <br />construclion. That I am authorized by the owner of this property to perfortn the work tor which applicadon is made and I comply with lhe <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />L. v��,� O`1- 1�-oS / <br />Si�ture of nedContrac or Aulhonze Agent Date � <br />