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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />Z A Sf~- SW 12Sv4-tvax)uq,� �Uj"a-go <br />LEGALI LOT NO. I BLOCK I TRACT <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />AAAIZk RuaroN (4Z5)53U- zAA <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE N <br />InT"f illAl o UV <br />HEATSOURCE <br />9 Electric A( Gas _A�Olhor <br />WORK DESCRIPTION <br />��0 X 3 � _ <br />24 X. ZO 2- e.AR GARhUE <br />PLUMBING <br />NO. ' TYPE OF FIXTURE OR ITEM <br />CONTRACT PRICE OF WORK <br />/'? %(u 6) <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash Lasin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar'moplela) <br />Backflow prevemor <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />I <br />A/C — airhandlingunits <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust tan <br />Heat pump <br />Unit heater <br />Boiler <br />Refriger3tlon <br />Woodslove <br />Other <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />Other <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 provis'ans of laws and <br />ordinacos 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 cancol the provision of any other sla*e or local law regulating construction or the performance of <br />construction. That I am authojW <br />d by the owner of this property to perform the work for which application Is made and I comply with the <br />W <br />ontrac rs w 18.27 a B�BgVJAC. <br />SI{ nature of Own r/Contractor/Authorized Agent Dale <br />IL <br />