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PERMIT 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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -7 <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />=tij v3 O �( T <br />-Uv <br />LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION # <br />DESC. �n7' _z ;%? _._ S(' t-t-S GJt�1t1 t LEI 1 M <br />_71A <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />0PE-MAIL —_ <br />C NTRACTOR ADDRESSITY/ IP PHONE <br />Sc: «vr FdW r.r� S <br />CONTR. LICENSE # <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />CK 4 Electric —Gas —Other <br />WORK DESCRIPTION <br />-�ZtA i= tfs->.0 1 Tr rJ //ZW oVvA 9_X/S>14 S�✓0� <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 />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <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 />_ A/C — air handling units <br />_ Forced air systems <br />_ Gas piping <br />_ Water heater <br />_ Gas fireplace <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 ceritify that I have read and examined this application and know the same to be true dnd correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whetter 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 />Slate Contractors Law 18.27 RCW and 296.200 WAC. <br />6 -U <br />1(2 <br />