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PEKMIT APPLICATION <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 AM17 TO 4 PM <br />SITE ADDRESS <br />= iiS <br />LEGAL LOT NO. <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICEPISE p <br />SC�V� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />� 1 <br />(�� � � ��-UL Q X �f ) ~/ <br />PARCEL TAX I.D. # <br />TRAC? <br />ADORESS <br />��i� ` � <br />CONTACT FOR PERMIT <br />� ° .� �.�c <br />AODRESS <br />� ��"� <br />HEATSOURCE <br />_ Eleclric _ Gas _ <br />PERMIT # <br />Mo,o 3-c� a�. <br />CITYIZIP PHONE <br />> r - i ���- 4rzs-.�s��-v�� <br />PHONE <br />yLS- ; 35-39 �Y <br />CITY2IP PHONE <br />�� <br />I CONTRACT PRICE OF WORK <br />Olher <br />w�ic� ►��` C�I�s� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BalhWh <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwaslier <br />Clalhes washer <br />Water heater <br />Sink (serviceNar/mopletcJ <br />Backflow 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 unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas (ireplace <br />Gasrange <br />Ciolhes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unil heater <br />Boiler <br />Re(rigeration <br />Waodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify lhal I have read and exainined this application and hno�v the same to be true and correct All provisions of laws and <br />ordinaces governinc� lhis type of work �vill b� complied wilh whether specified herein or not The granting of a permit does not presume <br />lo give aulhoriry to violate or cancel the provision o( any other stale or local law regulating conslruction or the peAormance of <br />construction. Th2t I am aulhorized by the owner of this property to perform Ihe work lor which application is made and I comply with lhe <br />State Contraclors La�v 18.27 RCW and 296.200 WAC. <br />�: �- 3//�%�7 <br />