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PL��MIT APPLICATIG�J <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 />3-a3-o� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. i! ERMIia� <br />zi3z sun,r���- ��e. Everc(i �18Zo1 I _ I� � 03'� � <br />� <br />LOT NO. <br />5a!"q <br />TENANTNAME <br />CONTRACTOR <br />Anc,�?rson <br />CONTR. LICENSE il <br />BLOCK I TRACT <br />z 13Z S�mmii-AJe Eveiet� 9�Zo/ 4/ZS-zs7 <br />I CONTACT FOR PERMIT <br />� <br />ADORESS <br />USE OF BUILDING HEAT SOURCE <br />S�n�IC' �'ou�t,lly 1�CS(�QY�GE _Eleciric �Gas_Other <br />WORK DESCRIPTION <br />D�v��de e���y <br />+ rP�oh,�9ure <br />CITY2IP <br />-� b��ld a nzas�e� b�,f�roa�, <br />/�iRSiCr �Jec.✓�vorti C�ose�, <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilat <br />Bathlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposai <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />BackOow praventer <br />Urinal <br />Drinking Fuuntain <br />Floor drain <br />Greasetrap <br />Roo( drains <br />Othar <br />PHONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />O oc� <br />i2eMo ve l��Gl closev� <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/G — alr hantlling UnitS <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Cblhes dryer <br />Rangehood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiier <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br />I hereby ceritify thal I have read and examined this application and know the same lo be lrue and correct. All provisions of laws and <br />ordinaces governing this rype of worK will be complied wilh whether specified herein or not. The grenting of a permit does not presume <br />to c�ive authonty to violate or cancel tne provision of any other state er local law regulating consWction or the performance of <br />construction. That I am aulhorized bv the uvner of this property to pedorm the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of OwnerlConlraclor/Authorized Agent Date � <br />2 <br />