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PERMiT APPLICATIO�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />Pw ��y � _� � <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />LOT N0. <br />BLOCK � iNACT <br />PARCEL TAX I.D. N <br />PERMIT N <br />� � <br />R•^��- Co�Ham�s aC��v<r�+F, t.0 3�1-zs-qb+►, Pi s� Ev�v �J-- �. e�ro. iVao <br />TEFIAN7 NAME � CONTACT FOR PERMIT PHONE <br />cun�nnciun n�,a <br />lN <br />CONTR. LICENSE N <br />� C�y�s��-�.�.�•�DDRESS <br />4zs. 8�0• ��30 <br />CITY2IP PHONE <br />_ roHsr�2qy���! _ <br />USE OF BUILOING � HEAT SOURCE � CONTRACT PRICE OF WORK <br />_ Elecldc �Gas _ Other <br />WORK <br />Cansi�u:-�- NfnN SIn9�-c -(iwiily V�61ci.2HC� <br />NO. I TYPE OF FI)(TL'QE OR ITEM <br />_L. <br />I <br />_; _ <br />TOilet <br />f1, lhlub <br />�avalury (wash basln) <br />Shower <br />Kitchen sink 8 dis�xisal <br />Dishwasher <br />Clolhes washer <br />Laundry Iray <br />Sink (sr.rvice/bar,'mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinkinfl Founfain <br />Floor drain <br />Grease irap <br />Roof drains <br />Olher <br />� <br />NO. <br />—L <br />� <br />Q I�i S I � Jli N WL` E/= � N� <br />--- � � l <br />MECHANICAL <br />TVPE OF FI%TURE OR ITEM <br />A/C - air handlinc� unlls <br />Foiced air sysloms <br />Gas pipinc� <br />Welor hoater <br />Gas firoplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaust fan <br />Heal pump <br />Unll heatar <br />Boller <br />RelrfgerAtlon <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />I hereby ceritify ihat I have road and examinoA ttis appllcalion anA know ihe same to be Inie and correc� All provislons ol laws and <br />ordineces yoverning Ihis typa o( work will be complied �,vith whother specified hereln or not. The gianting of a permit doas not presume <br />to pive aulhonry to vlolale or cancel the provision o( A�iy olher state or local law regulating cunsiruction or Ihe periormanc, ol <br />conslruction. That I am authorized by Ihe ownar o11YJs property to perform the work lor which application is made and I r.omply wllh the <br />StatA Conlraclors Law 18.27 RCW and 29Fi.200 WAC. <br />Signalur�OwnedCoMractodAuthorize Aqant ate <br />