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PE.tMIT APPLICATIO�d <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX �25-257-8857 - www.everetMM�a.org <br />�{�/ - °-� <br />gos�4-��3 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. p PERMIT # <br />.__, � �.,.�..�-�- .,,��- � � �;� 3 <br />LEGA LOT N0. <br />DESC. <br />9WNER <br />-�fM'1E�i �-l-o <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUII.DING <br />BLOCK I TRACT <br />I CONTACT FOR PERMIT <br />I <br />ADDRESS <br />HEATSOURCE <br />� Electric _ �as __ O;her <br />PHONE <br />CITY2IP PHONE <br />I CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />ADD EL�'R-t CAL N-CAT T-O f1-7Tf�CkfED GF11_I�G-E . �' Z l lN Tcuo W A ILS� <br />'�17 IN UNE WNLL� 1ZIS Tn /���c ��-�cN.. <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathtub <br />LavaMry (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop!elc.) <br />BackOow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />A�'C — air handling units <br />Forced air systems <br />Gas piping <br />'JJater heater <br />Gas fireplace <br />Gas range <br />Clothes dp�er <br />Ranae hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />BJIIBf <br />Refrigeration <br />Woudstove <br />Uther <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify lhat I have read and examined this appliwtion and know lhe same to be true and correct. All provisions of laws and <br />ordinaces governing ihis type of work will be complied with whether specified herein ur noL The granling ot a permil does not presume <br />in c�ive authonty to violale or cancel lhe provision o` any other state or local law regulating construction or the performance of <br />construction. That I am authorized by Ihe owner of this propeAy to perform the wnrk tor which application is made and I wmply with lhe <br />State Contractors Law 1827 RCW and.29fi200 WAC. <br />zm S <br />YJ <br />