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I��RMIT APPLICAT�.�N <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 />ar- <br />, `,.. <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM - DEBR d CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />LOT NO. <br />TENANTNAME <br />PARCEL TAX I.D. • <br />WA �gao► a9 os a o0o tio ys�o <br />BLOCK TRACT <br />'�lyG1�.1�,.E s� <br />CONTACTFORPERMIT <br />CONTRACTOR J�H, �Qno�er-k�.,�,,,ry °REss <br />CONTR.UCENSEN J � „�C�'I�Gf ��eYt%y <br />USE OF BUILDING <br />..,, Js <br />HEAT30URCE <br />P RMIT �1 <br />���-/� <br />'21P PF!ONE <br />��t `1P'�o� f4as)35�-i9a <br />PHONE <br />(4a5J 3So - i9a i <br />CITY2IP PHONE <br />s�oti�,,s1.�Kq. ydS"- <br />>���1 �;�l���D� <br />Electric •� Gas Other <br />WORK DESCRIPTION <br />�,,,,dtifi.,, r�p��.�r,.,�,r l-'IC('� oJ- oi J <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Olher <br />CONTRACT PRI eFpOF WORK <br />� �D���� <br />NO. I TYPE OF FI%tt1RE OR ITEM <br />A/C — air handiing units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit healer <br />Boiler <br />Reirigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby coritify that I have read and ezamined this application and know the same to be lrue and correcL All provisions of laws and <br />ordinaces governing lhis type o( work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to giva authority lo violate or cancel Ihe provision of any other state or local law regulating wnslrucdon or the perfortnance of <br />construction. That I am aulhorized by the owner of lhis property to periortn the work for which applicatlon is made and I comply wilh the <br />Stale Conlreclors Law 1$,27 RCW and 296.200 WAC. <br />I� <br />2 <br />