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PLAMIT APPLICATIG,J <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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE AC DRESS C1 or J Z PARCEL TAX I.D. # PERMIT # <br />LOT NO. I BLOCK <br />'r'{'-C 9 O E 1 r14 Co , <br />TRACT <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />Voc/riC <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br />+/-CA-4-�T M r &' Electric Gas Other /Vy/ <br />WORK DESCRIPTION <br />/n7sr,4c.l- / sctTlof✓ or- p4t,,c7- 4,4<,<, <br />NO. ) 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 tray <br />Sink (service/bar/mop/etc.) <br />Backffow preventor <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Jther <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/G - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby cenhfy that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this typo of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to viohle or cancel the provision of any other state or local law regulating construction or tLe performance of <br />construction. That I am authorized by the owner of this property to petiorm the work for which application is made and I comply with the <br />Slat Co tractor, aw 18.2) RCW d 296.200y . <br />. - a <br />ign a of Owner/Contractor/Authorized AgentT Date I G <br />