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P�r2MIT APPLICATI(��J <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 />a- � a' �`�5 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDS03 � C K//1 '` PARCEL TAX I.D. # PERMIT # <br />� -� �/U <I .� 5��� - ll� <br />LEGAL LOTNO. I BLOCK TRACT <br />CONTRACTOR T <br />CONTR. LICENSE # <br />USE OF BUILDING <br />L�� L� <br />WORK DESCRIPTION <br />����(<-7 � � <br />�� <br />(_ /� /' /j/',9„� . , . . ( <br />i <br />CONTACT FOR PERMIT <br />ADDRE55 <br />� <br />HEATSOURCE <br />�.n nur rnvnc � ` � <br />G <br />+'a��U� �/LJI.I����� 3�/��'�9 <br />PHONE <br />CITY2IP PHONE <br />� CONTRACT PRICE OF WORK <br />Electric ��Gas Other <br />_ � � .� �(..� � ��W ��F-I' <br />�� � <br />�� �� � <br />NO. I 1YPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Back(low preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />NO. <br />�� <br />TYPE OF FIXTURE OR ITEM <br />A!C - air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Ctothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refngeretion <br />Woodstove <br />CITY OF EVERETT IOCAL SALES TAX CODE IS J105 <br />I hereby ceritify that I have read and examined lhis application and know the same to be true and correct. All provisions cf laws and <br />ordinaces governing this rype of work wiil be complied with whether specified herein or not The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the pe�formance of <br />construction. That I am authonzed by the owner of this property to perform the �vork for which application is made and I comply with the <br />State Contracrors Law 18.27 RCW and 296.200 WAC. <br />� �� .� li S�f� � << C� � =%i �/r� t <br />, <br />Signature of O�vnevContracto /Authorized Agent Date �� <br />