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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 - DEBIT & CF EDIT CARDS ARE NO r ACCEPTED <br />SITE ADDRESS I PARCEL TAX I.D. # PERMIT # <br />ff <br />�rA J� Jt�Ey.�W h qpD 4qo� 1101LOT NO. BLOCK TRACT <br />/ll U LIL nnA_ <br />OWNER ADDRESS -- CITY/ZIP PHONE <br />,)VlatAde Milne( J�jtrlan $11 q3rd J} rtAl CtiW {, wA9bj9y_y3Ye61ql <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />CONT:2ACTOR 'n I ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE 0 ri4 r u <br />USE OF BUILDI Gjlr/ HEAT SOURCE CONTRACT PRICE OF WORK <br />n /1A(11 kondA4 11/Vr"P —Electric ✓Gas_Other I RAA <br />WORK DESCRIPTION <br />0"If- Moll i htllt� !w�(�cf►art <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />BackBow preventer <br />Unnal <br />Dunking Fountain <br />Floor drain <br />Grease trap <br />Root drains <br />Cthur <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ <br />_ <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 fkn <br />Heat pump <br />Unit treater <br />Boiler <br />Refrigeration <br />Woodstove` <br />4 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify 'hat I have read and examined this application and know tho same to be true and correct. All provisions of laws and <br />ordinaces 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. That I am authorized by the owner of this property to pe orm the work for which application is made and I comply with the <br />State Contracturs Law 18.27 RCW and 296.200 WAC. / r <br />U <br />