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P�RMIT APPLICATICSnI <br />CITY OF EVERETT PERMIT SERi/ICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM 70 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SIT� ADDRESS <br />13?� 1�'� � <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />��-�v��� ��-,o i <br />`TENANT NAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />BLOCK <br />)����ca5ter <br />(/1 Cl �JS-i� ✓ <br />PARCEL TAX I.D. # <br />TRACT <br />i 335 ��C f <br />ICONiACTFOR <br />ADDRESS <br />HEATSOURCE <br />_ Eleclric _ Gas _ Other <br />C-��� 5��01 �1�525q2 <br />PHONE <br />CITY2IP PHONE <br />� CONTRACT PRICE OF WORK <br />� �� f1�,v7— � d� ,�� /� `�- <br />NJ. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />_ Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry Iray <br />Sink (service/barlmop/etc.) <br />Backfiow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />�Gas piping <br />Water heater <br />� Gas fireplace <br />Gas range <br />Cbthes dryar <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unil healer <br />Boiler <br />Retrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3t05 <br />I hereby ceritify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing lhis type of work will be complied wilh whether specified hereln or not. The granting of a permit does not presume <br />to give authonry to violate or cancel me provision of any other state or local law regulaling construcdon or the pertortnance ef <br />construction. Thal I am aulhor,<ed by the owner o( this property to perform lhe work for which applicalion is made and I compty with lhe <br />Stale Conlraclors Law 18.27 FCW and 296.200 VJAC. <br />Signature of OwneAContractor/Aulhonzed Ayenl Date <br />