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PEkMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everethva.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # P RMIT # <br />l0/'� (Ylororan RD CX�:�933-(�00-11-1-� I � So� oo� <br />LO��T N�O. I BLOCK I TRACT ��_�� �� <br />�Q <br />H�t��' &a�-��s C�►�ST, 3q�, 8,{� A�E ti� �veaE � z 9�cs� �125 3�n- <br />TENANTNAME CONTACTFORPERMIT PHONE <br />"�,e� }-k�,ac�C �25- aqo- a� �.9 <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />Hc�cc e� ��us�. 3�aa ��+hav� �� �cTT q�a,�s <br />CONTR. LICENSE N <br />Nr��ck t�>zo � a�z �125- 3�1"1-�3 bo <br />USE OF BUILDING HEAT SOURCE CON7RACT PRICE OF WORK <br />NE�� J� � _Electric �Gas_Other � ���'�000 <br />WORK DESCRIPTION ' �� <br />6As�� �- <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Cbthes washer <br />Laundry tray <br />Sink (servicelbar/mop/etc.) <br />Backilow preventer <br />Urinal <br />Drinking Fountain <br />Floor drein <br />Grease trap <br />Roof drains <br />Other <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C — air hanCling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby ceriti(y that I have read and examined this application and know the same to be true and correct. AI� provisions of Iaws and <br />ordinaces governing this type of work will be complier with whether specified herein or not. The grenting of a permit does not presume <br />to give authority to violate or cancel the provision o!: ny other state or local law regulating construction or the performance of <br />construction at I am authorized QQ,,v the owner of this property to pe orm the work for which applicallon is made and I comply with the <br />St , t s Law \ 7 CW jh�I'296.200 Wf,C. � I � <br />`N� � 7 Q <br />y2 <br />