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P�r2MIT APPLICATIG�J <. �` <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 />�' �r� a�9 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NO ACCEPTED <br />SITE ADDRESS <br />_�3 �� <br />LEGA' LOT NO. <br />DESC� <br />� <br />TENANTNAME <br />%� <br />BLOCK <br />��tr v�,�1—vrw,+.u�- <br />PARCEL TAX I.D. # <br />TRACT <br />�. �40K �Y,s`r'-( <br />ICONTACT FOR PERMIT <br />PERMIT # <br />Co yll� <br />�ZS=2�9-'F�'S3— <br />PHONE <br />CONTRACTOR ADORESS CITY2IP PHONE <br />�,1Jl�tiVSc�n� iI"����� iGR3/rY��lec� ,4� �25-3357 <br />CONTR. LICENSE # g.Z2 3 <br />- ---- 6u�,�srn � � 2� <br />USE OF BUILDING <br />U �� <br />— HEAT SUURCE I CONTRACT PRICE OF WORK <br />p0 <br />ElecMc Gas Other l0/ �GQ <br />WORK DESCRIPTION <br />�t� c�rt B in�' �fL �U� �-��- � �� <br />NO. I TYP[ OF FIXTURE OR ITEM <br />Toilet <br />BathWb <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 />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <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 firepiace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES 7AX 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 />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 consWctlon 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 Contfactors La�y�18.27 RCW and 296.200 WAC. <br />