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P�,�MIT APPLICATIC.� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, Wq gg2p� <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 />SRc ADDRESS � PARCEL TAX I.D. p <br />PE IT / <br />dJG �4�33�1��►„� „ � i�-�n-?_ <br />LOTNO.� � BLOCK <br />L D'1'3•� i.,rit /1 i i <br />�o��N E, 01so�+ <br />iENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE t <br />USE OF BUILDING <br />�� R' , <br />WORK DESCe�a <br />�Gi,� �.JL�� <br />Lcr,�e�s A <br />aZa � � G(����✓uTsT, <br />CONTACT FOR PERMIT <br />ADDRESS <br />CITY2IP <br />HEATSOURCE �,,/)� <br />Electric _ ,r,as _ Other <br />�'A? v \�il �L{' � <br />��) (1 <br />NO. I TYpE OF FURURE OR ITEM <br />1 ollet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 dieaosal <br />Dishwasher <br />Ciothes washer <br />Laundry tray <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. <br />� <br />, , <br />!/er�,v,s� A <br />78���HONE <br />ra � ,4 yL' 76D � <br />PHONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />TYPE OF FDCTURE OR ITEM <br />rv� — air nananng units <br />Forced air systems <br />Gas pipinp <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer ^ <br />Range hood / VI � <br />E#iaustfan II P/`� <br />Heat pump �{�� <br />Unit heater <br />Bailer <br />Refrigerdtion <br />Woodstove <br />Other <br />C�TY OF EVERETT LOCAL SALES 7AX CODE IS J105 <br />' /�� <br />S `� / <br />I hereby ceritify that I have read and examined this applicatlon and know the same to be true and correct. All provisions of laws and <br />ordinaces goveming this rype of work will be complied wilh whether speci�ed herein or not. The granting of a pertnit does not presurne <br />to give authority to violate or cancel the provision of any other state or local law regulating consUucUon or the perfortnance of <br />constrvction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 1827 RCW and 296.200 WAC. <br />� <br />�,J,,�-['... �� (�.1�.,, 3 - y_ oS <br />