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PERMIT AF'PLICATION <br />CITY OF EVERET7 PERM17 SERVIGES <br />3200 CEDAR STREET EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />SITE ADDRESS <br />[H�]:11:TiLNt�I:i <br />CONTR. LICENSE � <br />�.�.c-,ac.a <br />USE OF BUILDING <br />S� � <br />WORK DESCRIPTION <br />`��� <br />0������ ��� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />BLOC!! I TRACT <br />ICONTACT FOR PER�dIT <br />ADDRE55 <br />��uftY, _ <br />I HEAT S')URCE <br />CITYIZIP <br />� � s-n, , <br />�') . <br />PERMIT # , � <br />�!;�/ "»( <br />� � � � � <br />PHONE <br />�u c�z5�33'�•�s; <br />PHONE <br />PHONE <br />. � . ' � ./_ <br />_ Electric � �;as _ Olher <br />� <br />�� �- ��-'� <br />/__ c7 `�._ _ �. �� <br />N0. I TYPE OF FI%i URE 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 (service/bar/mop/etc.) <br />Backtlow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Greas= trap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />MtGFiAMGAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handlir�g units <br />� Porced air systems <br />.� G�s piping <br />1 Water healer <br />! Gas fireplace <br />i Gas range <br />� Clothes dryer <br />� Range hood <br />(o Exhaust fan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeraiion <br />Woodstove <br />� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />I hereby ceritify that I have read and examined this application and know the same to be [rue and correct. All provisions of laws and <br />ordinaces governing this type of work will :,e complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local la�v regulating construct�on or the performance of <br />conslruction. That I am authorized'oy the owner of this property to pertorm the work for which application is made and I comply with the <br />S:atg Contractors Law �8,27 R�V�and 296200 WAC. �, � . <br />