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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-2;i7-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />� ( M c. <br />LEGAL LOTNO. BLOCK <br />DESC. <br />OWNER <br />A NA� M-�CI I ZQb� ��k <br />N � �. <br />CONTRACTOR �� � o� <br />CONTR. LICENSE M <br />USE OF BUILDING <br />�� • , <br />� <br />WORK SCRIPTION <br />1�� <br />LUMBING <br />N0. I TYPE OF FI%TURE OR ITEM <br />� <br />� <br />� <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 (servicefbar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Orinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />IPARCEL TAX I.D. N <br />TRACT <br />ADDRESS <br />t� 43�701titm(Jtc � <br />CONTACTFORPER R <br />ADDRESS <br />HEATSOURCE <br />_ Electric � Gas _ Other <br />l��p� � l <br />NO. I <br />PHONE <br />CITY2IP PHONE <br />I CONTRACT PRICE OF WORK <br />TYPE OF FI%TURE OR ITEM <br />A/C - air handiing units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Ezhaust tan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3705 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work wi�l be complied with whether specifiad herein or not. The granting of a pertnit does noi presume <br />to give authority to violate or cancel the provision of any olher state or local law regulating constniction or the peRormance of <br />construction. That I am authorized by �he owner ot this property to peAorm the work for which applicatian is made and I comply with the <br />StatelZontraclors L6w 18.27 RGW and 296.200 WAC. <br />i <br />� '— �? <br />��L <br />