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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 70 4 PM <br />,�r E ADDRESS I PARCEL TAX I.D. # P IT M <br />/t" 2�?'1 �ta n� i�a � �t'V� , �''D`f �1�7i <br />LEGAL LOT N0. BLOCK 1RACT OR SUBDIVISION # <br />DESC. <br />OWNER �� ADDRESS CITY2IP PHONE <br />�� o��y��-�� �.�� �33 ► Md,��o��v�,EvE�e�rr�u��� ti,8,�u�,, <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />E-MAIL <br />� �CONTR. LICENSE p � <br />(� l�� �V �= a <br />USE OF BUILDING � HEAT SOURCE I CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />�Cliiill��J'1 <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />:.lothes washer <br />Water heater <br />Sink (service/bar/mopletc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />Eleciric Gas Other <br />N0. I TYPE OF F�XTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood �" <br />Exhaust tan <br />Heal pump <br />Unil heater <br />Boiler <br />4efrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />54�5�� <br />I hereby cerilify that I have read and examined this application and know lhe same to be true and correcl. All provisions of laws and <br />ordinaces governing this lype of work will be complied wilh whether specified herein or nol. The granting of a permit does nol presume <br />to give authonty to violate or cancel Ihe provision ot any olher stale or local law regulating consWclion or lhe pedortnance of <br />conslruction. That I am aulhorized by ihe owner of lhis property to pertorm the work for which application is made and I wmply wilh the <br />Stale ConUaclors Law 18.27 RCW and 296.200 WAC. <br />