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P�RMIT APPLICATIO��I <br />CITY OF EVERETT PERM�T SERVICES <br />3200 CEDAR STRcET, EVERETT, WA 98201 <br />� 425-257-8810 — FAX 425-257-8857 — ww� .everetiwa.org <br />��'�� <br />APPLICATIONS ARE ACCEPTED FROM 0 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE P.DDRESS PARCEL iAX I.D. # <br />''�' � Gi � �D.D3 ZoE <br />LEGAL LOT NO. BLO K TRACT <br />DESC. - - — <br />� %/YZI, i� //J�=' 'C� i ( CrA-20iti� <br />TENANT <br />CONTRACTOR <br />CONTR. LICENSE # /j%�� /_������� <br />/J (J <br />USE OF BUILDING <br />WO 'K DESCRIPTION <br />ntfrur�f�..� B� <br />CONTACT FOR PERMI7 <br />ADDRE7SS ��� <br />�CJ7/ ti'�C� f��C L'`lJ <br />HEAT SOURCE <br />Eleclrc � Gas _ Other <br />CITY/ZIP <br />�I%ir fct��c <br />. �� - — <br />PHONE <br />PHONE y�C L„� <br />J <br />�.� yG <br />�ONTRACT PRICE OF WORK <br />pG -� <br />/.f� �. �'� l kyle ��.�-/y r�s�d�� <br />�ti!�C <br />PLUMBING <br />NO. � TYPE OF FIXTJRE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drein <br />Grease trap <br />Roof drains <br />Other <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C - air handling un�ts <br />Fomed air systems <br />Gas piping <br />W ater F:aater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Rangehoud <br />Ex'�aust fan <br />Heai ��ump <br />Unil h �ater <br />Boilar <br />Re(rigeralion <br />Woodstove <br />Other_ <br />CITY QF E\'ERETT 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 correcL All provisions of laws and <br />ordinaces governing ihis rype of work will be complied with whelher specified herein or not. The granting of a permit does nol aresume <br />lo give aulhority lo violate or cancel the provision o� any other slate or local law regulaling conctruction or the performance of <br />construclion. That I am aulhorized by lhe owner of this propeAy to pedorm lhe work for which application is de and I comply with the <br />State Conlractors Law 18.27 RCW and 296.200 WAC. <br />� , �2�� � <br />Signature of GwnedConlraclodAulhorized Ager�t Da� <br />