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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — Fl,X 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM l� �- ��6 <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />�n��. ���,�a ��,r�, C,»�s-��- I �b�i�i�tY�4nInC71 ic"��-/� --()��� <br />10 <br />�0�5`��.r r;5(l ��'fY�.l`,�(�I`l �I� �c' <br />TENANTNAME CONTACTFORPERMIT <br />�i�.I�h,�a ('.n� <br />CONTRACTOR ADDRE55 CITYIZIP PMONE V <br />Gl�ti�r�blin IUI�135{�ti��C�u�S�. �ve��f=�; �a5-5�1-1531 <br />CONTR.LICENSEK / IL��7[-1 k)�1�1� �"�`-' <br />� <br />USE OF BUILDING � HEAT SOURCE I CONTRACT PRICE OF WORK <br />WORK DESCRIPTIQ�J I� �� <br />�IF.W 3,�� �a,rYi, � <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toitet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbar/mopletc. ) <br />Backtlow preventer <br />Urinal <br />Drinkmg Fountain <br />Floor drain <br />Grease irap <br />Roof drams <br />Other <br />Eleclric �as Other <br />i:[�ll <br />TYPE OF FI%TURE OR ITEM <br />hIG — au hantlung units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Heatpump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TA% CODE IS J105 <br />I hereby centdy that I have read and ezamined this applicahon and know the same to he true and correct. All provisions of laws and <br />ortlmaces goveming Ihis type of work ��II be complied wdh whether specdied herein or not The grannng of a pertnit does nol presume <br />to gwe authority to violate or cancel Ihe provision of any other state or local law regulating construction or the performance of <br />construction. Tnat I am authorized by the owner of this property to perform ihe work for which application is made znd I comply with the <br />StateLontractors Law 18 27 RCW and 296200 WAC. <br />