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PE�2MIT APPLICATION <br />CITY OF EVERE � T 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 />SITE ADDRESS p <br />•�� _ � it.a� � £_ <br />LEGAL LO7 NO. BLOCK <br />DESC. <br />OWNER <br />,.l ; �er <br />TENANT NAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />� %%i'� <br />WORK DESCRIPTION <br />{�c� do r'oa F <br />PLUMBING <br />NO. I TYPE OF rIXTURE OR ITEM <br />Tailet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />W ater heater <br />Sink (serviceibar/mop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />1 PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />ADDRESS CITY2IP <br />l�/9-S� `� � 5'. � C�ve� <br />CONTACT FCR PERMIT <br />ADDRESS CITYIZIP <br />— HEATSOURCE I <br />Eleciric _ Gas Other <br />S —I 5-��7 <br />PERMIT # <br />QG�OS-O'- <br />PHONE <br />� �� �'��� <br />PHONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />_I A/C — air handling unils <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas Tireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustian <br />Heat pump <br />Unit heater <br />Bailer <br />i2e(rigeration <br />Waodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TN( CODE IS 3105 <br />I hereby ceritity lhat I have read and examined lhis applicalion and know the same lo be true and correct. All provisions of laws and <br />ordinac<s goveming this type of work will be complied with whether specified herein or not The granting of a pertnit does not presume <br />to give authoriry lo violate or cancel lhe provision of any other state or local law regulating construction or lhe performance of <br />construction. Thal I am authorized by the owner of this p-operty lo perform the work for which application is made and I complY with the <br />State Conlraclors Law 1827 RCW and 296200 WAC. <br />��� 1 /i�,���� .5 �%S-O� <br />