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PERIVIIT APPLIG�4TION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 t� `� � �� � <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADORESS (,�n i � � <br />�1 a � . +ti �J��— <br />LEGAL LOT NO. BLOCK <br />DFSC. L� <br />OWNER <br />�� uC.' U Ft C�YYI P� l�W �v� � <br />TENAT1i� NAM � <br />CONTRACTORS���� �cJ A'��,�� <br />CONTR. LICENSE #L�( <br />USE OF BUILDING <br />WORK DESCRIPTION <br />aa`�i�s <br />�G`'-'�i(: =�� 7.%��� <br />PLUMB!NG <br />NO. I TYPE OF FIXTU!tE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & dispos3l <br />Dishwasher '�, _ , �. ' <br />Clothes washer <br />Laundry tray <br />'��nk (service/bar/mo�/etc.) <br />Backflotv preventeh ' <br />Urinal <br />DrinY.ing Fountain <br />Floor drein <br />Grease trap <br />Roof drains <br />Other <br />PARCEL TAX I.D. # <br />TRACT <br />u�� �03-29 <br />PERMIT # <br />�i�1t��.LYi•S�e�� �r't:'�ever,s ..33y �5"73 <br />Rr.�.:�2.r_M W A 9�254� <br />CONTACT FOR PERMIT PHONE <br />ADORESS CITYIZIP <br />HEATSOURCE <br />_ Electric � Gas _ Other <br />NO. <br />n <br />PHONE <br />CONTRACT PRICE OF WORK <br />TYPE OF FI%TURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump � ` ' <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and axamined this application and know the same to be true and correct. All provisions of laws and <br />urdinaces �oveming this type of work will be complied with whether specified herein or not The granting of a permit does not presume <br />to give authority ro violale or cancel the provision of any other state or local law regulating construcLon or the performance of <br />construction. TY�at I am authorized by the o��ner of this property to perform the work for which application is made and I comply with the <br />State Contractors law 1827 RCW and 296200 WAC. , , <br />��� <br />