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� <br />PEi�MIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 G�6 —�7 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADPRESS PARCEL TAX I.D. # <br />�� t, �e. �� � O\G �: ,�j <br />LEGAL LOTNO. BLOCK TRACT <br />DESQ �i I� ,�. ^ <br />OWNER � ADDRESS CITYIZIP <br />L a^� 'r4G��e��v�v•'h�C. ',�110 �S.t�t.S�eve�nS �lz.Ste,�enS <br />� � �� ..�.�--�nn °r5c21�51 <br />TENANTNAME <br />. i <br />ti , <br />CONTRACTOR <br />CONTACT FOR PERMIT <br />J.ODRESS <br />PERMIT # <br />PHONE <br />CITYlZIP PHONE <br />- O> <br />- .. ' . > . . <br />CONTR. LICENSE i{ � � • <br />LCC-� aC NOy�IR1`� <br />USE OF BUILDING I HEAT SOURCE � CONTRACT PRICE OF WURK <br />WORK DESCRIPTION <br />� 2�I.J <br />aa�y -c-,G`�\� <br />_ Electric �Gas _ Other <br />�i '�al�,� <br />��; ,., ;' � <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />C�othes washer <br />Laundry tray <br />Sink (ssrvice/barlmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <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 />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />O�her <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and 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 speci6ed herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any olher state or local law regulating construction or the performance of <br />construction. That I am aulhorized by Ihe owner of this property to pedorm the work for which application is made and I comply with Bie <br />State ContractorslaW 1827 RCW and 296.200 NJAC. ,/ , <br />�� Z <br />