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PCRMIT APPLICATI(�nl <br />CITY OF EVERETT PERMIT SERVICF;i <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 ADDR;E�S�S� ��� <br />r '-,� "I��S'> a� � � <br />IEGAL LOT NO. BLOCK <br />DESC. <br />OWNER <br />TENANTNAME <br />T��,' ��' <br />CONTRACTOR �/�� 7`—��� � <br />��7 � -��� � �` <br />CONTR. LICENSE # <br />�/�TH �S �k <br />USE OF BUILDING I <br />WORK DESCRIPTION <br />PARCEL TAX I.D. ii <br />TRACT <br />CONTACT FOR PERMIT <br />ra►� �l � a ►�� a � <br />ADDRESS — <br />� �,o,�yx5853 � <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />/-rr 4..� S. -� ; y��SS�'Ul�1 <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilcl <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Waler heater <br />Sink (service/badmop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinkin� Fountain <br />Floor drain <br />Grease lrap <br />_ Rool drains <br />Other <br />2 -7-0� <br />PERMIT q � <br />l� U'/l- `_� <br />PHONE <br />PHONE <br />�3-9��-.� <br />CITY2IP PFiONE <br />`fiuKu�,� °t- �.06 <br />�� l 3� 3S� -911� <br />sys7�� <br />NO. <br />CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas Tireplace <br />Gas range <br />Cblhes dryer <br />Range hood <br />Exl iaust fan <br />Heat pump <br />Unit heater <br />Builer <br />Re(rigeration <br />Woodstove � <br />Olher � <br />Y.'i'�/h��.CS�'O!% S <br />Y <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify lhal I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br />ordinaces governing lhis rype of work will be complied �vith whether specified herein or noL The granting of a permil does nol presume <br />to give authority to violale or cancel the provision of any olher slale or local law regulating construction or the periormance of <br />construclion. TNaI I am authorized by the owner of Ihis property lo perform the work for which application is made and I comply with the <br />SWIe Contract6rs Law 18,27 RCW, and Z9G.200 WAC. <br />