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PE,tMIT APPLICATIO�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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DE81T 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # RMIT # <br />. �- �.���I��l'� '. �� �.�� . ''. /�"�;.%.�.1-!J',"lCll���LG DI � <br />LEGA LOT N0. BLOCK TRACT <br />DESC. '��� I���;�<.'-!�t .I�IU:�J ���� <br />9WNER AD�RESS GITY2IP PHONE i � <br />, � � .. -. . � .. - = � '. <br />r <br />� ' , ' � 1 , � d' � � .. . � � �� . '..'_ �:� j,�%',.' . `N/'`- "��r �; in -� I�Z <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />� � � ��G�.�L <br />. �;nl, �J�1�.1�1�1 �fY/' <br />CONTRA'�fOR - �, �, � A�DRESS CITYIZIP PHGNE <br />CONTR. LICENSE # <br />USEOFBUILDING ,�i� ;,,,_ �-� „ <br />;�� ���., , , <br />WORK DESCRIPTION <br />>� �;1 <br />,'. <br />HEATSOURCE <br />�1�''. �i }/✓ <br />Eiectric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />,�� � . I-E'l; F.r��' :,. ;, ��,�,��'! .'-'�� :z% <br />_ , � ,- , _ �;,�. , L. (,':;�, �f�:J j !�'�,J�' ���:/-� <br />�^ , = <br />.�� . , �J�;�... i�: I'�t:.h�.i'i�-L;i <br />ND. I TYPE OF FIXTURE OR ITEM <br />i Tailet <br />Balhtub <br />l.avalory (wash basin! <br />Shower <br />� Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbar/mop/etc.) <br />Backilow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other _ <br />N0. TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />� Waterheater <br />Gas fireplace <br />Gas range <br />Clathes dryer <br />Range hood <br />� Exhaustfan <br />i Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 1'105 <br />�� I hereby ceritify tha:l have read and examined this application ana kno�v the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authonty to violate or wncel the provision of any other state or local ta.v regulating construction or the perfortnance of <br />construction. That I am authorized by the owner of this property to perform the work tor which application is made and I comply with ihe <br />i Slate ��tractors Law �827�RC1�aod 290.200 WAC. <br />�/ (�/ouJ <br />_.y....._.__. _.. _ _ ... _ ___. - _- „ <br />Tuor-t � •l�Ti�1 <br />�L <br />