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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetiwa org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. M <br />• , � ', r � �; -�m �r<, rn o <br />LLG . LOT NO. `BLOCK TRACT <br />' , . �-,1�1� <br />TENANTNAME <br />'S., � <br />',� .� ,i ,, :. f .. <br />CONTRACTOR ��� ��,�� „ {j����., <br />CONTR. LICENSE N <br />� � .� ,� • <br />USE OF BUILDING <br />WORK DESCRIPTION <br />i �. � � . �.� I. <br />, ..��h:�. t �. <br />N0. <br />d � - )"! .� J�J. �+.� � <br />PERMIT M <br />I CONTACT FOR PERMIT PHONE <br />l � -7 �'� � <br />�.'r�7���� _"D�'�i � ''" - <br />ADDRESS CITY/ZIP PNONE � � ^ I <br />,. �� L,�� ���/1 � � ��-.rl'� � ,•('�I�� '�,�J �'Z <br />, . �� , � i � ��,� <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Eiectnc _ Gas _ Other � <br />— •J, ��c� <br />. ' • <br />�; � <br />, � , � ' . , � . , _ � <br />�� <br />TVPE OF FIXTURE OR ITEM <br />Toilet <br />Dathtub <br />Lavatory (wash basin) <br />Shower <br />KRchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Smk (service�barimo��'elc ) <br />BackOow prevemei <br />Urinal <br />Dnnkmg Fountam <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />:Gl <br />TYPE OF FIXTURE OR ITEM <br />AIC – art handling units <br />Forced a�r systams <br />Gas piping <br />Water neater <br />Gas f�rAplace <br />Gas range <br />Clo�hes dryer <br />Range hood <br />Ezhausifan <br />Heal pump <br />Umt healer <br />Boder <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL 9ALES TA% CODE IS J105 <br />I hereby cenbfy Ihal I have read and eaamined this application and know the same to be irue and r,orrect All provisions of laws and <br />nrdinaces govermng Ihis type of work wdl be complied wdh whether specdied herein or not The granting of a permit does nol presume <br />to grve authonty to violate or cancel Ihe prowsion ol any other state or local law regula6ng construcUon or lhe perlortnance ol <br />construclion That I am authorized by the owner ol lhis property to perform the work for which apphcahon is ma90 and I comply with ihe <br />5 le cjrllr�ctois a 18 27 RCW and 296 200 WAC <br />li,��l.�..r��.�_ ������-�.- <br />