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SITE ADDRESS <br />LOT <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />000 <br />PARCEL TAX I.D. M <br />TRACT OR <br />TS�e11e Nyq� � COI�RACTFORPERMR <br />J <br />a I V�CS � ToW r� i Co�crtir <br />`'� Town� 4 Ca�Y Posr �tE � tosz� ►�vw 9°►, S <br />CONTR.LICENSER �K„W�� W� <br />T�wN c PFo°19 �T <br />USE OF BUILDING <br />WORK DESCRIPTiON <br />HEATSOURCE <br />_ Eleclric � Ga^ _ Olher <br />5_D7-i0 <br />PERMIT N <br />I-�U , -' <br />�2 <br />p PHONE <br />rtvt_� 1�3 (2a <br />PHONE fyzs�'143 - I <br />8�� (H2�j 743-1555 <br />qa� S� �e�ac�d Pa�+ �ra.++�� Bw�►a�� <br />NO. I TYPE OF FlICTURE OR ITEM <br />Toiiel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Ciothes washer <br />Water heater <br />Sink(service/bar/mopletc.) ,�� <br />Back9ow preventer <br />Urinal <br />Drinking Founlain .� � <br />Floor drain �/'� <br />Greasetre� <br />Roof dr ' s <br />_ Olher <br />CONTRACT PRICE OF WORK <br />►q, I TYPE OF FIXTURE OR ITEM <br />AIC — air handling uni+� <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heat pump � '� <br />Unil heale� ' <br />Boiler <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby ceAify Ihat I have read and examined this application and know the same to be true and correct. AII provisions of laws and <br />ordinances goveming this type of work will be complied wilh whether specified herein or nol. 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 perfortnance of <br />construction. That I am aulhorized by lhe owner oi tfiis propeAy to peAortn lhe work tar which applicalion is made and I oomply with the <br />State Contracto�Law 18.7] RCW and 296.200 WAC. � <br />� <br />