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P'�_RMIT APPLICATI(.�V <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 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />/%%� <br />LEGA LOTNO. <br />DESC. �3 � �j <br />OWNER <br />� �� � � � <br />TEN T NAM <br />� c�� <br />CONTR CTOR <br />CONTR. LICENSE R <br />�-A �,3 <br />�C iUr<c cJ <br />BIOCK TRACT <br />� V <br />ADDR <br />�s`� 1 n�.,,�2 <br />Dw� <br />USE OF BUILDING <br />�{ '' � Ge ' <br />W012K DESCRIPTION <br />�i <br />,�" � ��'� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilot <br />Batlifub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washcr <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Back(IoH prevenler <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Grease trap <br />Roof drain� <br />Cther <br />PARCEL TAX I.D. iM <br />CONTACT <br />P�RMIT# � <br />_do� cJ -�- <br />� <br />CITY/ZIP PHONE <br />C���uo�.�tr`G�a..9p,�.� a <br />HEAT SOURCE <br />�Electric _ Gas _ Other <br />'� �� h� <br />4"ll s.F, <br />CITY2IP <br />hP��l �Lou2 <br />PHONE <br />�y�f. �0�- <br />PHONE <br />0 <br />CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water healer � �� <br />Gas fireplace <br />Gas ran�e <br />Clolhes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unit healer <br />Boiler <br />Refrigeralion <br />Wuodslove <br />Olher_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritity that I have read and examined this applicalion and know the same lo be true and correct. All provisions of laws and <br />ordinaces govemin� this type of work will be complied with whether specified herein or nol. The granting oi a permil does not presume <br />lo give aulhoriry to vioiate or cancei lhe provision o( any olher state or local law regulating construction or lhe performance of <br />construcl�on. That I am authorized by lhe owner of lhis property to peAorm lhe work for whir.h application is made and I comply wilh the <br />State Eontractors Law 18.27 RCW and 296200 WAC. <br />��2 <br />