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PE��VIIT 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 n/, �5/� 3 <br />/"GLJ <br />APPLICATIONS aRE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />��LEGAL LOT NO. <br />TENANTNAME <br />BLOCK <br />. . <br />CONTRACTOR �`uE'����('�St <br />CONTR. LICENSE # <br />_ `��uc,2ei <br />USE OF BUILDING <br />S/N6L�t � i�y_IeES, <br />WORK DESCRIPTION <br />TRACT <br />PARCEL TAX I.D. t� <br />� �O/OU2 D <br />ri <br />i:ONTACT FOR PERMIT <br />. i� <br />� <br />� <br />PHONE <br />. M • � ' <br />'C AUORESS CITY2IP PHONE <br />`-Po3o5c 3aZ `�uvp.ct `l�'0/9 <br />�• • . �zo6) �/9-��-1i3 <br />HEAT SOURCE �. CONTRACT PRICE OF WORIC <br />Electrc � Gas _ Other I � 6� p dd <br />/t ��'cJ G✓crr�, � i4.-�� o�.G' r2 <br />N0. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />�s.c � I 63 <br />N�. � TYPE OF FIXTURE OR ITEM <br />WG — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />W�odstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 7105 <br />I hereby ceritity that I have read �.nd examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does net presume <br />to give authonty to violate or cancel the provision of any other state or local law regulating const�ucdon or the perform2nce of <br />construction. T a am authorized by the owner of this property to pertorm the work for which applicatlon is made and I comply with tha <br />Slate Contractor aw 18.27 RCW and 296.200 WAC. <br />'�l'lT�C' /v -s-or' <br />/ <br />