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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />q2._5-257-8810 — FAX 425-257-8857 — wuvw.everettwa.org <br />APPLICATIONS ARE ACCEP fED FROM 8 AM TO d PM <br />SITE ADDRESS � {�, PARCEL TAX I.D. # <br />!�t rq- 5o s� s � ��� <br />LEGA LOT NO. BLOCK TRACT OR SUBDIVISION # <br />DESC. <br />OWNER ADDRE58 <br />Scotl- E7liS /�i5� 5a �rt -s� <br />TENANT NAME <br />CONTACT FOR PERMIT <br />A <br />Fve�# 98103 ��S-3'fb- 0�`�3 <br />PHONE <br />A�lelE A" ✓��I�P�F��� I E-MAIL <br />CONTR. LICENSE N <br />USE OF BUILDING <br />t' ltU �� 7"Gi� <br />WORK DESCRIPTION <br />HEATSOURCE <br />_ Electric V Gas _ Other <br />��/�1Z7'%�%���, �`7 i�/t��%�� <br />U <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishv:asher <br />Clothes .vasher <br />Waten c�ater <br />Sink (service/badmop/etc.) <br />Backtlow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handiing units <br />Forcad 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 />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinances governing this type of work will be complied wilh whelher specified herein or not. The granting of a pertnit does not presume <br />�o give authority to violate or cancel the provision of any o�her state or local law regulating construction ar the pertormance of <br />construction. That I am authorized by the owner of lhis propeRy ta perform the work for which application is made and I comply with the <br />State Coniractors Law 18.27 RCW and 296200 WAC. <br />