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P��MIT APPLICATIV�J <br />CITY OF EVERETT PERMIT SERVICES <br />, �y�_os <br />� <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 ACCEPT <br />SITE ADDRESS PARCEL TAX I.D. # PE IT # <br />3 0 3 w M vl i e�� U?� - ��ZD <br />LEGA LOTNO. BIOCK TRACT <br />DESC. <br />OWNER Auuttcaa �.���rur •����� <br />, 5 j�!p 7" Z C/'�-� ��� S l� d�� 3503 w m vei a ra--zj $�- v p <br />TENANTNAME CONTACTFORPERMIT PHONE <br />CONTRACTOR <br />i:ONTR. LICENSE ii <br />USE OF BUILDING <br />WORK DESCRIPTION <br />ADDRESS <br />HEAT SOURCE <br />Electric Gas Other <br />� � �/ <br />1����j.J/ <br />�;.. <br />N0. I TYPE OF FIX7URE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposai <br />Dishwasher <br />Clothes 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 />CITY2IP PHONE <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTl1RE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Bailer <br />Refrigeralion <br />Woodslove <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3705 <br />I hereby cerilify that I have read and examined this application and kno�� the same to be true and correct. All provisions of laws and <br />ordinaces govemin� this type of work will be complied wilh whether specified herein or noL The granting of a permit does not presume <br />to give aulhoriry lo violate or cancel lhe provision of any olh��r stale or local law regulating conslructlon or lhe performance of <br />construclion. That I am aulhorized by the owner of this prcp=_rty to perform lhe work for �vhich application is made and 1 comply wilh the <br />Slate Conlractors Law 18.27 RCW and 296200 WAC. <br />Signature o( OwnedContractor/Authonzed Agenl Date <br />