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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.everettwa.org <br />`/b/ APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM (-3 O-Ov <br />SITE ADD ESS_ 1,1 �t ` PARCEL TAX �DtN� r 7 PERMIT�1, <br />LEGAL LOT NO. BLOCK TRACTOR SUBDIVISION R <br />OEsc. IJTS <br />.L <br />OWNER ADDRESS :IFY1zIP PHONE <br />TEN)WT. NAME ^` ONTAC,T. F—OR ``ERMtT PHSINE <br />� � C V Ck`V e l cI,"v +�1y. �V+vw k?,�'41y �Z . <br />-TE-MAIL r N <br />ADDRESS GITYIZIP PHONE <br />L(Gn�� \V uwI��71G-f�1 �%u•:-flrN �j�i.'S �.T �'i: NC idi i�l�c'fT � �:�•� � �i -21 i� <br />CONTR. LICENSE RC```Z f< fie, C%3-,t��Ll .I;Vh rl <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />\,j� u � W%? tD \ei'i _ Electric —Gas Other 4 lob. Ci ri <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ Toilet <br />_ Bathtub <br />_ Lavatory (wash basin) <br />_ Shower <br />_ Kitchen sink 8 disposal <br />_ Dishwasher <br />_ Clotheswasher <br />_ Water heater <br />_ Sink (sarvico/bar/mop/otc.) <br />_ Backllow preventer <br />Urinal <br />_ Drinking Fountain <br />_ Floor drain <br />_ Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />_ Forced air systems <br />Gas piping <br />_ Water heater <br />_ Gas fireplace <br />_ Gas range <br />_ Clothes dryer <br />_ Range hood <br />_ Exhaust Ian <br />_ Heat pump <br />Unit heater <br />_ Boller <br />_ Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCK 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 correct. All provisions of laws and <br />ordinates governing this typo 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 provision of any other state or local taw regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application Is made and I comply with the <br />State Contracts s'Law 18.27 R and 296.200 WAC. L <br />/Signature of wner/ o raclorrAuthoriZed Agent wife— I/T <br />