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a <br />� PERMIT APPUCATION <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />—�^'r'��! _ " �: � L �r:��r� �/r�:Jl <br />LEGAL LOTNO. BLOCK <br />DESC. <br />� rc <br />TENANTNAME <br />���'J I T N i� <br />CONTRpCTOR <br />! CONTR.UCENSEM <br />I USE OF BUILDING <br />S ._ri c� <br />� WORK <br />IPARCEL TAX I.D. M <br />�.J� i"� / I � <br />TRACT <br />- ; i�: � n�: ..,,..� v i��:' /-1 � <br />CONTACT FOR PERMIT <br />! 1 <br />-b l,� :. l.�lr i ������-iL <br />AODRESS <br />v <br />CI7V21P <br />�— �� ��% <br />PEtjMI N <br />> // 'l> `% <br />10NE <br />�/Si 3`i) CS7i <br />PHONE <br />��11 1=J��L <br />PHONE <br />HEAT SOURCE I CONTRACT PRICE OF WORK <br />_ Electnc _ Gas Othar �� �/� � . <br />�1��� <br />�� /� a��<. Z-� x L: �/ <br />NO. TYPEOFFIXTUREORITEM <br />ionet <br />Bathtub <br />_ Lavatory (wash basln) <br />Shower <br />_ Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />_ Laundry tray <br />_ Sink(service/badmopfetcJ / �� . <br />_ Backtlowpreventer Sf �� <br />Unnal , �i't. <br />DnnkmgFountam ��'�.�'� � <br />_ Floordrain � <br />Grease trap <br />Root drains <br />_ Other <br />No� I TYPE OF FIX7URE OR ITEM <br />_� <br />_ A/C — air handling units <br />_ Forced air systems <br />_ Gas piping <br />Water heater <br />_ Gas fireplace <br />_ Gasrange <br />_ Clothes dryer <br />_ Range hood <br />_ Exhaust fan <br />_ Heat pump <br />_ Unitheater <br />_ BoBer <br />_ Refngera0on <br />_ Woodstove <br />CITV OF EVERET7 LOCA� SALES TA% CODE IS 7105 <br />; � <br />I hereby centify ihat I have read and eramined this applicauon and know the same to be true and cortect. All provisions of laws and <br />ordinaces govermng this type o( vrork will 6e complied wrth �vhether speafied herem or not The granting o( a permrt does not presume <br />to give authonry to violate or cancel ihe provision of any other state or local law regulating wnstruction or the perlormance of <br />construction. That I am authorized.by ihe ovmer of this pmperty to perform the work for which appliwtion is made and I comply wi�h the <br />State Contractors Law 1827 RCW and 29G200 WAC. <br />_ - ;� ' i -y-� �� �Z_/ .., <br />� �% <br />