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F�RMIT APPLICATI �N <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 & CREDIT CARDS ARE NOT ACCEPTED <br />S�'3 (�/ S�-�'Q.55 �9-�l Si' c� o� 3�7 �`7 ;32b1S-o � PSM'S� /- n in <br />LEGA LOTNO. BLOCK TRACT � <br />C �� <br />TENANTNAM� <br />CONTR CTOR — / <br />F S�QH F2 <br />CONTR. LI ENSE # <br />to L� �E- � <br />USE O�ING <br />H�22L�1 � ✓'� <br />CONTACTFOR <br />ADDRESS <br />�4 � 5 �'� 5�' <br />HEAT SOURCE <br />_ Electric _ Gas _ Other <br />CITYlLIP <br />��/' �4tD <br />l.1/ %4 <br />PHONE �1' �^ <br />��2 / 2� a <br />PHONE / /2 r <br />c� i-z I 2 U C� <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />� N 5fu L i� ���� �s 0 l� /�lo IJ -�LLuw L%�c S o Q/ <br />E�,�r�,� c.u�t�c. 's ox� Ea �7- d. wPg i EL.Qv�rt-� ��v <br />NO. I TYPE OF FI%TURE OR ITEh7 <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced alr systems <br />Gas piping <br />Waler healer <br />Gas fireplace <br />Gas range <br />C�olhes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVEREIT LOCAL SALES SAX CODE IS 3105 <br />I hereby ceritify that I have read and examined lhis application and know the same lo be true and correcL AII provisions of laws and <br />ordinaces governing this type o( work will be complied wilh whelher specified herein or not. The granting of a permit does not presume <br />�to rve auihorily to violate or cancel the orovision of any other state or local law regulating construction or the performance of <br />� n truction. That I am authorized by the owner of this property to peAorm the work for �vhich application is made and I comply with the <br />e Contractors La�x18.27 RCW and 296.200 WAC. � ,. <br />1I� <br />