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P�r�MIT APPLICATIC.�� <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />5T ; !�J <br />LOT N0. <br />PARCEL TN( I.O. # <br />�o� � 1v GU�(� O�a h !_ �2 � a o /�, � 5 t � c�l �,��r77 N�1 5��/� " _ ` _ ., . _ <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />CONTRACTOR .1 i.. N1'}C C—a41S �JCT�I.I4DORESS CITY2IP PHONE <br />� Sa-oy Zz�'' �'I. �.f . <br />CONTR. LICENSE M� G,yy�l}�.��fYCD �--�'V�""e�'�% l�.J'' 9 g� 3�" <br />USE OF BUILDING <br />�-�aac� <br />WOkK DESCRIPTION <br />� �1�� «.) L_ <br />NO. ; TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (waeh basin) <br />Shower <br />Kitchen sink 6 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Slnk (serviceibar/map/etc.) <br />Back(low preventer <br />llrinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />O�her <br />— HEAT SOURC�E/ I CONTRACT PRICE OF WORK <br />/� � <br />ElecMc Gas __ Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forr.ed air systems <br />Gas piping <br />W eler heater <br />Gns fi�eplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat Vump <br />Unit heater <br />Boiler <br />RefrigeraLon <br />Woodstove <br />CITY OF EVERETT IOCAL SALES TAl( CODE 18 7105 <br />I hereby r,eritify Ihat I have read and examined this application znd know Ihe same to be trua and correcL All provisions o( laws and <br />ordinaces governing this rype of work will be complied wilh whether specified herein or not The grenting ot a permit does not preaume <br />to g�ve authonty to violate or cancel the provision of any other ctate or local taw regulating construction or the peAormance of <br />construction. That I am authonzed by the owner of this property to perform Ihe work for which application is maCe and I comply with the <br />Slate Contractors Law 18 27 RCW and '�96 200 WAC. <br />