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SITE ADURESS <br />LOT NO. <br />PERMIT APPLICATION <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 />PARCEL TAX I.D. # <br />a.VE • I <br />BLOCK TRACT OR SUB�IVISION # <br />��- c� -�5.,��—r <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />E•MAII <br />TR ADDRE S IT /ZI P <br />CONTR. LICENSE M <br />USE OF BUILDING <br />lo �-d�'1' <br />PERMIT # <br />-oK <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric Gas Other <br />WORK DESCRIPTION <br />�Ss-wty- P�.�'^,`'� c�n.S �tPirJc.ti �r� Er�'Tc��''- s;rs+� <br />C��ee.A-r� <br />NO. I NPE OF FI%TURE OR ITEM <br />Toilet <br />6a�htub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishtv�5her <br />Cloth��,vasher <br />Waler healer <br />Sink (service/bar/mep/etc.) <br />Backllmv pmvenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasc Irap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Wa1er healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit hea�er <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify ihat I have read and exatnined ihis application and know the same lo be irue and correct. All provisions of laws and <br />ordinances goveming this type of work will be complied wdh whather specified herein or no'. The granling ot a permit does nol presume <br />to give authonty lo violate or cancel ihe provision o( any other stale or Iocal law regulating conslruclion or Ihe pertormance of <br />construclion. That I am aulhorized by the owner of this property to perform ihe work fonvhich application is made and I comply with the <br />State Coniractors Law 1827 RCW and 29G.200 WAC. <br />Sic�naWre of OwnedConUaclodAu�horized Agenl Dale <br />