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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-'L57-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PF,i <br />SITE ADDRESS <br />o - � �,.. � �1 <br />LEGAL LOTNO. BLOCK <br />DESC. <br />OWNER <br />(� �c ��a1�Gri �e g . <br />TENANT NAM�� <br />o K;(�� <br />l� ; .z U �j- <br />CONTR. LICENSE # �v ti � 7 c� 2 � <br />USE OF BUILDING <br />WORK DESCRIPTION � S IGt�'� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Ki�chen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/elcJ <br />Backllow preventer <br />Urinal <br />Drinking Fountain <br />F!oar drain <br />Grease lrap <br />Roof drains <br />Olher — <br />PARCEL TAX I.D. q <br />TRACT OR SUBDIVISION N <br />CONTACT FOR PERMIT <br />7tc_ wntsil ( �% f(u'`� /% yi¢ <br />�6 �r `-�J-l� <br />HEATSOURCE <br />_Electric _Gas,_Other <br />GC��(r%!►�Q � �✓ <br />NO. <br />� <br />,,..ab <br />PERMIT ft <br />PHONE, 7� h_ v r/( O <br />�Lr- � <br />E-MAIL Gv�a�'��SiAs� ooim <br />c- ynh��� ��s� <br />���7C/� 0760 <br />CONTRACT PRICE OF WORK <br />� �� <br />$ �. � , <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstave <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify Ihat I have read and examined this application and know the same to be true and correct. All pravisions of laws and <br />ordinances governing this type of work will be complied with whether specified herein or not. The granting o/ a pertnit does not presume <br />lo yive authority to violate or cancel the provision of any olher state or tocal law regulating construction or the performance oi <br />construclion. Thal I am authorized by the owner of lhis property to perform the work for which applicalion is made and I comply wilh lhe <br />Stale Contraclors J.aw 18.27 RCW and 296.200 WAC. <br />a �— l <br />� <br />