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1 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8850 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEf. TAX I.D. R PERMIT • <br />LEO LOT NO. BLOCK TRACT OR SUBDIVISION 0 C L \ <br />DES, <br />�I—CIA- , a.r�ICn Ccv Ccr,rbJ <br />oyy R­ 0P <br />1 '�`. '7,'11 1, 6.:,,.,L. h, . SLIP 27L 1 C veiefl cj6`7.01 U1S 2 12 ZttO <br />W�iOn N..1 A --,x, 2, r""''. %4�' ,.e, <br />CONTR. LICENSE M <br />R �"SL Q tptrFf iercl,..e cl�tvT <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />A."', it I (. r)1, 11 �Cl rrr ll/r( (rmid <br />Electric _ _ Gas Olhar <br />A ai klrr rV — <br />WORK DESCRIPTION (1 <br />KV'CLJ 'V17'u% 1 )CYo. J), '), L I <br />NO, I TYPE OF FIXTURE OR REM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbar/mop/etc.) <br />Badc9ow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Root drains <br />Other ____-__ <br />I _ <br />i <br />_I <br />_ <br />_ <br />NO. ' TYPE OF i IXTURE OR ITEM <br />A/C: — air handling units <br />Forced air systems <br />Gas p-ping <br />i <br />Water heater <br />_ <br />Gas fireplace <br />Gas range <br />= <br />Clothes dryer <br />Range hood <br />1 <br />Exhaust fan <br />_ <br />Heat pump <br />_ <br />Unit heater <br />_ <br />Boiler <br />_ <br />Refrigeration <br />_ <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 trua and cormit. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified heroin or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other stale or local law regulating construction or the perk rmance of <br />construction. That I am authorized by the owner of [his property to perform the work for which application Is rradn and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />_.. I i11irI,I�; <br />.m <br />