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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 q` a q—�� <br />425-257-8310 – FAX 425-257-8857 – www.everettwa.org <br />(��� ��S'J � ' �� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS AR NOT ACCEP7ED <br />SITE ADDRESS <br />LOT N0. <br />TENANTNAME <br />CONTRACTOR <br />Ij� (i-i SAr� KpMeS <br />CONTR. LICENSE / <br />USE OF BUILDING <br />1�7 <br />BLOCK � TRACT <br />PARCEL TAX I.D. N <br />� <br />_ I`''CONTACT FOR�ERMIT PHONE <br />�c�r �r� ��z,�nc�� 2,U(� • y 1�- !�u'1 <br />ADURESS CITYIZIP PHONE <br />=hc. io�ai f_vu9reenWr+laS•�173 �vueit4��1p(Ka,S•43f5-1o31�9 <br />WORK DESCRIPTION <br />R�i,,�,t�� �'�� ul,u,�n <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drein <br />Grease trap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ Elr.ctric ✓ Gas _ Other <br />NO. <br />CONTRACT PRICE OF WORK <br />�rv�je.c,-�- C�ar�e. ; <br />�c�dd� La.ne. <br />TYPE OF FIXTURE OR ITEM <br />wc — air nanaiing urnts <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hocd <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />ReFrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7A7C CODE IS J105 <br />I hereby centify that I have read and examined this application and know the same to be true and correct All provisions of laws and <br />ordinac�s governing this type of work will be complied with whether specified herein or not. The grenting of a pertnii does not presume <br />to give authority to violate or cancel the provision of any other state or tocal law regulaling constvctlon or the peAormance of <br />construction. That I am auihorized by the owner of Ihis property to pedortn the work for which application is made and I comply with the <br />State Contractors Law 1827 F�CW and 296200 WAC. <br />�t /� /�?�-- <br />�� <br />