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PEr2MIT 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 />3-�a-os <br />APPLICATIONS AF�E ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS j� PARCEL TAX I.D. # PERMIT M <br />�vy `�� H�qk��� N��. C SU� ���� <br />LOT NO. � I BLOCK I TRACT <br />DESC. <br />TENANTNAME CONTACTFOft�PERMIT � PHONE <br />I �wve U/���s�so,�. <IaS-svf3-3C�i�y <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK <br />Ul.!°>R7 j2ovh, ia��o <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />DrinMing Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEATSOURCE <br />ElecMc Gas Olher <br />�a�: <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A1C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas Tireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this spplication and know the same to be true and correct. All provisions of lavls and <br />ordinaces goveming ihis type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />� to give authonty to viclate or cancel the provision of any other state or local law regulating construction or the perfortnance of <br />consVuction. That I am authorized by ihe owner of this property to perform the work for which application is made and I comply with the <br />,�late Contractors Laa� 18.27 RCW and 236.200 WAC. <br />�/ <br />Z <br />