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F-ERMIT APPLICATI�N <br />CIT'Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STF :ET, EVERETT, WA 98201 <br />425-257-8810 — FAX 4� •2�7-8857 — www.everettwa.org <br />y7c/ Sa y� ��� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PIA _ <br />SITE ADDRESS <br />LOT NO. <br />DESC. <br />BLOCK I TRACT <br />PARCEL TAX I.D. N <br />PEkM1T # <br />(3cs c�o5 :�_ <br />�' a b��ii� �niii 90 - ..3-� a r �'7/�. /! `�2r �FF�29✓Z _ <br />TENANT NAME I CONTACT FOR PERMIT PHf?NE <br />. / <br />� %7f,C'T/3 � ii <br />CONTRACTOR <br />ADURESS <br />CONTR. LICENSE N O — <br />(�Jti4�" <br />USE OF BUILAING I HEAT SOURCE <br />WORK DESCRIP��ION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilat <br />BalhWb <br />Lavalory (wash basin) <br />Shower <br />Kilclien sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Olher <br />Eleclric Gas Qlher <br />CITV2IP <br />PHONE <br />CONTRACT PRIC[ OF WORK <br />NO. I TVPE OF FIXTURE OR ITEM <br />NC — air handling unils <br />forced air systems <br />Gas pipinc� <br />Waten c�ater <br />Gas lireplacQ <br />Gas range <br />Clotlies dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeralion <br />Woodstove <br />Olher <br />CIT�' OF EVERETT LOCAL SALES TAX CODE IS J705 <br />I hereby ceritify Ihat I have read and examined Ihis application and know the same to be lrue and corzecL AII provisions of laws and <br />ordinaces c�overning this type of work will be complied with whether specifed herein or not. The grenling of a permit does not presume <br />lo give authority Io violate or car.cel Ihe provision of any other state or local law regulaGng construclion or the psrformance of <br />conslruclion. That I am authorized by the owner of ihis property lo pedorm the work for which application is made and I comply with the <br />State Contractors Law 1827 RCW and 296.2001"AC. <br />SignaWre of OwnedContraclor/Aulhorized Agenl Date <br />