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PERMIT APPLICATION , <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 />SITE ADDRESS <br />LEGAL LOT N0. <br />DESC. <br />ONMER <br />'1 <br />�)���I��` I'���"r �i <br />TENAHYNAME '� <br />CONTRACTOR .f � � � 1 j � � <br />CONTR. LICENSE • <br />USE OF BUILDING <br />WORK DESCRIPTION <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />r �� <br />� � : �', -� , � . <br />� ',1� � � <br />N0. I NPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 tlisposal <br />Dishwasher <br />Clothes washer <br />Laundry lray <br />Sink (service/bar/mop/etc. ) <br />Backflow preventer <br />Urinal <br />Dnnking Fountain <br />Floor drein <br />Grease trap <br />Roof dreins <br />Other <br />PARCEL TAX I.D. M <br />� . <br />}'1i `�C ,J��/c.�'���' <br />TMCT <br />i;, �' �;c�J�f�7�� ;�� r1Z'%' <br />� CONTACTFORPERMIT <br />ADDRE55 CITV/ZIP <br />— HEATSOURCE I <br />Eledric Gas Other <br />PERMIT A' <br />� � � <br />, 7 . <br />PHONE �,/r/ <br />� CI J �L f' <br />,,,_ <br />l r' � <br />PHONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplac: <br />Gas renge <br />Clothes dryer <br />Range hood <br />Ezhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refngera600 <br />WoodstOve <br />Other <br />CITY OF EVERETI' IOCAL SALES TAX COOE IS J706 <br />I hereby ceritify that I have read and =zamined this application and k�ow the same to be true and wrred. All provisions ol laws and <br />ordinaces governing ihis rype of work vnll be comphed with N�he�her specifEd herein or not. The yranting of a pertnit does not presume <br />to give authoriry to violate or cancel the provision of any other st.�ce or local law regulating construnion or the performance of <br />construction. That I am authorized by the ovrner of this property ic peAorm ihe work lor which appl�cation is made ano I comply with the <br />State Cdntradors Law 1827 RCW antl 296200 WAC. <br />}7 �, <br />� <br />. �II ��-�U ��� I i�r i�_ � �-" �� ��(�'U�. <br />