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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 982121 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS EVaPQ-++ LOA 98a03 I PARCEL TAX I.D. # I PER! <br />LOT NO. <br />DESC <br />TENANT NAME <br />BLOCK I TRACT <br />CONTACT FOR PERMIT <br />PHONE <br />ME5;j�!jE'a— -�� O +�# �,\ �h I I/�4rL�o�►y�G a53-85�-ao�Cn <br />E NTRACTOR 1v ag—AI� 1 1 IZCJ I�1II IADDRESS <br />Hniej� rW�iI F�ZN a53-&S�-aostP <br />CONTR. LICENSE# r— I Il:•�'^i•A(J ),Ih2 Iwo qg3�9 <br />Fvmnr-.1? AICI 9 RhM2 LJ '�^ <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Electric _ Gas _ Other Ito <br />1 Q� 00 <br />WORK DES i q 1_L �`l (Z� ,fit t n K YL a�5 rtr► zt lvin+-SQA CE <br />ING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ Bathtub <br />_ Lavatory (wash basin) <br />_ Shower <br />_ Kitchen sink 8 disposal <br />_ Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />_ Grease trap <br />_ Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ <br />A/C — air handling units <br />_ <br />Forced air systems <br />_ <br />Gas piping <br />_ <br />Water heater <br />_ <br />Gas fireplace <br />_ <br />Gas range <br />r\ <br />Clothes dryer <br />Range hood <br />�1 <br />Exhaust fan <br />Heal pump <br />.. <br />•.I1 v <br />'Unit heater <br />Boiler <br />Refrigeration <br />(�� <br />I <br />Woodstove <br />CITY OF EVERETt LOCAL SALES TAX CODE IS 3105 <br />I hereby centify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />orchmaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Sta' Contractors L w 1 7 RCW and 296.200 WAC. <br />