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P�RMIT APPLICATIt,�V <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 <br />SITE AJDRESS <br />LOT N0. <br />TENAN7NAME <br />CONTRAGTOR��f'�� �I��� /n� <br />S K, <br />CONTR. LICENSE p ��� � � � �q¢� <br />USE OF BUILDING I <br />PARCEL TAX I.D. # PERMIT # <br />(��►l�Cc- C� <br />TRACT OR SUBDIVISIOI� # <br />CONTACT FOR PERMIT <br />� <br />I HEATSOURCE <br />�/ <br />Eleclric �Gas _ Other <br />WORK DESCRIPTION �� /�/ �1 b ���i � w� �Ce,G <br />!" / <br />��-iA. l`��6:�C_ - Y'/�°-�'rri /�1.�/�.�c7� 0� �?/"'UiJr��/� <br />(i �� <br />NU. I TYPE OF FIXTURE OR IT[h1 <br />Toilet <br />Balhtub <br />Lavalory (wash basm) <br />Shower <br />K.ichen sinA 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/etc.) �Lv-�.�*�'� �a y <br />BockOow prevenler <br />Urinal <br />Drinking FouNain <br />Floor drain <br />Greasc lrap <br />Roo( drains I <br />Olher , � t^�'^ S� �" <br />@Na <br />� <br />PHONE <br />E-MAIL <br />� <br />rnvne <br />{�i1�5 9�,5Z <br />¢,��-a�o a��� <br />CONTRACT PRICE OF WORK <br />-90�`� <br />ll <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater d <br />Gas lireplace <br />Gas range ✓ <br />Clolhes drycr <br />Range hood <br />Exhauslfan <br />Heal pump <br />Unil heater <br />Boiler <br />Relrigera�ion <br />Woodstove <br />f,ITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined lhis 2pplication and know lhe same lo be lrue and correcl. All provisions of laws and <br />ordinaces governing lhis lype of wode will be complied �vilh whclher speci(ied herein or not. The c�ranting of a permit does not presume <br />lo give authoriry to violale or cancel lhe provision of any other state or loczl law regula�ing construction or the pedormance of <br />construclion. That I am authorized by Ihe owner ol lhis property lo periorm lhe work for tivhich applicalion is made and I complv with the <br />Stale Conlraclors Law 78.2 RCW and 2B6. 00 WAC. <br />�i -� �/i. �. . ��� / � � =09 <br />6/S/�� � <br />