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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />32DO CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.crg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. N P,BRMIT N <br />yam$ y&^ no.c-CA-! 117 %b> <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />U j1« k-va <br />TENANTNAME CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CrTYZP PHONE <br />CONTR. LICENSE t` <br />USE OF BUILDING I — HEAT SOURCE u _Q� I CON iRACT PRICE OF WORK <br />�ac^uc�e Electric Gas Other <br />i <br />WORK DESCRIPTION <br />E a. S\. nc, <_y �`i �K �'.ac�..\��^��.c\�a�L.l w .\ti c.-� Ci.`�.c�•' <br />,r 7 <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ Toilet <br />_ Bathtub <br />_ Lavatory (wash basin) <br />_ Shower <br />_ Kib:hen sink 8 disposal <br />_ Dishwasher <br />_ Clothes washer <br />_ Laundry tray <br />_ Sink (servicelbarlmopletc ) <br />_ Backfiow 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 fi•eplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby centify that I have read and examined this application and know the same to be true and correct. All provisions PC NS and <br />ordmaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not F:3sume <br />to give authority to violate or c-,acel the provision of any other state or local law 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 Contractors Law 18.27 RCW and 296 2DO WAC. <br />St' <br />igat6 <br />ne o`erlteontraador\ zed Agent <br />sty 1 /z <br />