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PLMIT APPLICATIGA <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 is CREDIT CARD;; ARE NOT ACCEPTED <br />SITE ADDRESS - PARCEL TAX I.D. # ?ERMIT ## —7 <br />LEGAL LOT NO. BLOCK TRACT <br />DESC, <br />ADDRESS CITY2IP PHONE <br />C I•haitc i Cl •Ct C� � <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTORp iC'rlh 11,`` Sk1Z1r ADDRESS CITY/11 PHONE <br />�rxrUld H�� CONTR. LICEL.U- l ub �1zlrlc1'(LU kc�t <br />NSE <br />r I� 1 ILAF�.�I$OMQ <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />Electric _Gas /1 Other <br />WORK D <br />`,,itI1 SCRIPTION <br />Ir>��rtr�cle/ �-��m Q2i�2a�o <br />N0. I TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />A/C — air handling units <br />_ <br />_ <br />Lavatory (wash basin) <br />Forced air systems <br />Gas piping <br />_ <br />Shower <br />Water heater <br />Kitchen sink 8 disposal <br />_ <br />Gas fireplace <br />Dishwasher <br />Gas range <br />Clothes washer <br />_ <br />Clothes dryer <br />Laundry tray <br />_ <br />Range hood <br />Sink (service/bar/mop/etc.) <br />preventer <br />_ <br />_ <br />Exhaust fan <br />Heal pump <br />_ <br />UrinalBack(l <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Unit heater <br />Boiler <br />Refrigeration <br />_ <br />Grease trap <br />Roof drains <br />Other <br />_ <br />Woodstove <br />Other <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing 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 to violate or cancel the prevision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this propert7 to perform the work for which application is made and I comply with the <br />Slate Contractors Law 18.27 RCW and 296.200 WAC. <br />'/(-r) <br />to �� <br />