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PERMIT APPLICATlON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-25�-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEP'fED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />��nn� S�`" ��SG� <br />LEGALI LOT NU. BLOCK <br />TENAN'. NAME <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISiON # <br />CONTACT FOR PERMIT <br />C' �09 �o/� <br />� 70 % -l/�� <br />PHON'c <br />� E-MAII_ <br />CONTRACTOR ADDRESS CI IZIP PHONE <br />CONTR. UCENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION �� S/� ,e L r-�� <br />��s�'� 77�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhlub <br />Lavatory (wash basin) <br />Shower <br />t�itchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Waler heater <br />Sin� (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />HEATSOURCE <br />_ Electric � Gas _ Other <br />CONTRACT FRICE OF WORK <br />r�l-C,rt�( Ik y C( S-QGtLG<�' — Le.rN <br />�rif'� c.'i <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A!C — air handling units <br />Forced air syslems <br />Gas piping <br />Waterheater ( , <br />Gas fireplace � I „u <br />Gasrenge �1 i�� <br />Clothes dryer �� <br />Range hood � <br />Exhaustfan <br />Heat pump n � <br />Unitheater �,/G <br />Boiler 1i� <br />Refrigeration <br />Woodslove <br />Other <br />� � LtJ'� — <br />CITY OF EVERE7T LJCAL SALES TAi( CODE IS 3105 <br />I hereby ceriti(y thal I have read a�d examined this application and know the same lo be lrue and correct. All provisions of lav:s and <br />ordinaces c�overning this lype of work will be complied wilh whelher specified herein or not. The grantiny of a permil Coes nol presume <br />to give authority to violate or cancel the provision o( any other stale or local la�v regulating construc�ion or the performance of <br />construclion. Thal I am aulhorized by the owner of lhis property to perform lhe �.vork tor which application is made and I comply with the <br />State Conlrectors Law 1827 RCW and 296.200 WAC. <br />