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F ..:RMIT APPLICATiGN <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 />LICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />2E3S 6ew4Ai PARCEL TAX LD. # PERMIT# <br />y ;t. i q — -- ►v� -=�o� - any <br />LOT NO. BLOCK TRACT <br />ADDRESS �TY�IP S PHONE <br />a O ,nci J V_E6,1Q0&:) • 39'7.Oaa 11 <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE # Ui� <br />USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br />SI L <br />Electric —Gas —Other <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 />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />BackBow preventer <br />Urinal <br />Drinking Founiein <br />Floor drain <br />Grease trap <br />Roof drains <br />Othei <br />NO. I TYPE OF FIXTURE OR ITEM <br />(A/G - 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 fan <br />Neal 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 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 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 provision of any other state or local law regulating construction or the performance of <br />construction. Thet 1 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 Lbw 18.27 RCW and 296.200 WAC. /} <br />