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P�RMIT APPLICAT'I�.N <br />CITY OF EVERETT PERMIT SERVICES <br />32U0 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 ACCEPTED <br />SITE ADDRESS <br />LEGAI LOT NO. <br />DESC. <br />�VcELltnli <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />I`r s K, , <br />BLOCK <br />USE OF 6UILDING <br />l.Z r't�ct ['l ,�Ci �cc��l.r� ii.�i.�C <br />� <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilei <br />Bathtu6 <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes �vasher <br />_ Laundry tray <br />Sink (service/badmop/elc.) <br />Backilow prevenler <br />Urinal <br />Drinking Fountain <br />� _ Floor drain <br />� Grease trap <br />I _ Roof drains <br />Olher <br />PARCEL TAX I.D. # <br />, <br />_. • _ ? i <br />TRACT <br />�l^�f lJ ��E'Sr'Lcrt�f'�lt /1uc � 1,'t'�trfl <br />I CONTAGT FOR PERMIT <br />ADDRESS CITY2IP <br />HEATSOURCE I <br />,� Electric _ Gas _ Other <br />PERMIT # <br />/C � / d - <br />�������� ���Z���70-�� <br />PHONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />N0. I 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 dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refnge2tion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />hereby ceritify that I have read and ezamin<d this application and kno�v ihe same to be true and correct. All provisions of laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or not The granting or a permit does not prasume <br />to give authonty to violate or cancel the provision of any other state or Incat law regulating construction or the performance of <br />consWction. Thai I am authorized by the owner of this property to perform the �vork for tvhich application is made and I comply with the <br />Slate Contractors Law 18.27 RCW and 296.200 WAC. <br />�I/,.�— /G'/3i <br />ny <br />