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PERMIT APPLICA.TION <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 <br />SITE ADDRESS <br />�-1G �L-{�P��'��vo <br />LOT NO. I BLOCK <br />PARCEL TAX I.D.1� PERMIT / <br />oOy(Qy-1�0�05-t00 pX,��e- <br />TRACT OR SUBDMSION N <br />pr�V� C-ri�yE� 4�-IG o�.-�s-�P�c..'��vn EvEx�Y, �sila. <br />TENANTNAME CONTACTFORPERMIT PHONE <br />�� �{��"l� I �b'C"\E E�a� -3�-1-�i-1�d <br />O� N�� <br />CONTR. L�CENSE # <br />USE OF BUILDING <br />�Es� b�c'� P,� <br />WORK DESCRIPTION <br />HEAT SOURCE CONTRAC7 PRIGE oF woKR <br />Electric � Gas _ Other N l P <br />�E - �ooF �ov�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishw2sher <br />Clo�hes washer <br />Water healer <br />Sink (service/bar/mop/elc.) <br />Back9uw prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roo( drains <br />Other _ <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />A/C — air handling unils <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas tireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslave <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />I hereby ceritify thal I have read and examined lhis appiicadon and know the same lo be true and correcL All provisions of laws and <br />ordinaces goveming Ihis type o( work wili be complied with w•hether specitied herein or noL The granting oi a permit does not presume <br />to give aulhoriry lo vio�ate or cance� lhe provision ol any other slate or local law regulating construclion or the perfortnance of <br />conslruction. That i ain aulhorized by the owner of this property to peAortn the work (or which application is made and I comply with lhe <br />State Conlractors Law 18.27 RCW and 296.200 WAC. � <br />