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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR ST�EET, EVERETT, WA 98201 <br />•425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />,9PPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />�i5%F� -���� <br />LOT NO. BLOCIC <br />DESC. <br />TENANTNAME <br />PARCEL TAX I.D. # <br />TRACT <br />CONTACT <br />Pl?RMIT # <br />c. o t�c Z-WS <br />/�' fJL S�J � <br />CONTRACTOR �y,J,�JL� L�4J r.^�— F"JG AL'�ORESS �(�SQ�% L� �3 �~%h <br />CONTR. LICENSE # jj�I�/J�-r� � �%� / N ii <br />USE OF BUILDING HEAT SOURCE <br />Electric was Olher <br />WORk DESCRIPTION <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />$ f /" <br />itsJaen sink & disposal <br />Clolhes washer <br />W ater healer <br />Sink (service/badmop/elc.) <br />8ackflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drair, <br />Grease tra,: <br />Roof drains <br />Other <br />cw� {.�„pFi� E� � <br />`lic) <br />CONTRACT PRICE OF WORK <br />�i ��a,ouo <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />�Iothes dryer <br />Range hood <br />Exhaust tan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />Oiher_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know lhe same to be true and correcl All provisions of Iaws and <br />ordinaces governing lhis type o( work �.vill 6e complied wilh vihether specified herein or not. The granling of a permit aces not presume <br />lo give authority to violate or cancel the provision of any other slate or local law regulatir.g construction or lhe performance of <br />construction. That I am authorized by the owner o( this property to per(orm lhe work (or which application is made and I comply �vith the <br />Stale Contractors l,aw 18.27 RCW and 296.200 WAC. <br />Z <br />