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IT APPLICATIGIN <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 />���I <br />SITE ADDRESS <br />LEGAL LOT NO. <br />DESC <br />OWNER <br />TENANTNAME <br />!C�'�L T��� <br />ONTRACT R <br />H ��e�� <br />CONTR. LICEMSE # <br />USE OF BUILCING <br />WORK DESCRIPTION <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />• � PARCEL TAX I.D. # <br />BLOCK TRACT <br />ADDRESS <br />�CONTACT FOR PERMIT <br />�TAru� f �t�Ax <br />�A� R� �/, �`�'S �' <br />�_ <br />I HEAT SOURCE <br />_ Eleclric _ Gas _ Olher <br />��� ��,��% °� <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />BalhWb <br />Lavalory (wash basin) <br />Shower <br />Kitclien sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbadmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof �rains <br />Olher <br />� <br />PHONE <br />CITY2IP PH��IE✓���^/y <br />,�•(�7 y, <br />�lvi�cL f�'(3� � <br />I CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forr,ed air sysleR,. <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaust tan <br />Heal pump <br />Unil heater <br />Boi�er <br />Refriyeralion <br />Woodstove <br />' Olher `, <br />— � �� V �� S <br />CITY OF EVEREI'T LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritity thal I have read and examined this applicatinn and know lhe same to be true and correct. AII provisions of laws and <br />ordinaces governing this lype of work will be complied wilh wi�ether specified herein or nol. The granting of a permit does nol presume <br />to give aulho�ry lo violale or cancel the provision of any other ;tate or local law regulaling conslruclion or the performance of <br />construction. Thal 1 am authorized by the owner o( lhis propert;� to peAorm the work forwhich applicatiun is made and i comply with the <br />State t ctors Law 18.27, � 296.2, 0 AC. � I / <br />/ v U <br />_ .S7n.w,,. r...,�..,��... ulhn ari nwnt Dale <br />