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P��RMIT APPLICATIE,N <br />CITY OF EVERETT PERMIT SERVICE� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CR:DR CARDS ARE NOT ACCEPTED <br />SI7E ADDRESS <br />�IZ.I� �(�LW � t• <br />DESC. <br />LOT NO. <br />BLOCK <br />�a �� iJ �C. 1ModLJ�.I'J <br />TENANTNAME <br />CONTRqCTOR <br />/1ti��-250V <br />CONTR. LICENSE A <br />USE OF BUILDING <br />I�n�� <br />PARCEL TAX I.D. X <br />TRACT <br />(�M�6 �8`t„►o�zl <br />ICONTACT FOR PERMIT <br />PERMIT r <br />M C� 5� <br />�(zti 3�? v <br />ADDRE33 CITY2IP PHONE <br />� u 5� nu, A� � o cJ '(�jv r ���,�,� <br />WORK DESCRIPTION 1�5 �� l t <br />NO. I TYPE OF FIXTURE OR ITEM <br />I ollet <br />Bathtuu <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/baNmop/etc.) <br />BackBow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease �rap <br />Roof drains <br />Other _ <br />�� <br />HEAT SOURCE I CONTRACT PRICE OF WORK <br />✓ Eledric � Gas Other � <br />�as -�� r�� �a,c�t. l �'S�eJ � <br />NO. I TYPE OF FUCiURE OR ITEM <br />�w — air nananng umts <br />Forced alr systems <br />Gas pipin� <br />W ater heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3705 <br />I hereby ceritiy that I have read and ezamined this application and know the same to be irue and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or npt. The granting of a permit daes not presume <br />to giv�authority to violate or cancel the provision of any other state or local law regulating conshuction or the perfortnance of <br />const ction. That I am authorized by the owner cf this property to perform Me work for which application is made and I comply with the <br />Sta(e ontract�aw 18.27 RC�N and 296.200 WAC. <br />