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� <br />P MIT 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 />S�TE ADDRESS <br />� v 9 /t a o'..e ••, � <br />IEGAL LOTNO. BLOCK <br />DESC. <br />TRACT <br />PARCEL TAX I.D. # <br />PERMIT i1 <br />GL/�GER /�Ie�P6/lTi�S �34�09 �c��./�.��� �v�� � JG�-Z£'r�"o, <br />TENANTNAME CONTACTFORPERMIT PHONE <br />CONTRACTOR `qh �J ��/�` •/%�N7, s� r� ADDRESS o- /,�o�s)`r-/� CITYIZIP ' PHONE L.i'�-3� <br />� �G��- <br />CONTR. IICENSE p <br />�-f�/��I P�� ��7�� � <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavaloiy (wash 6asin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washor <br />Wa�er hea�er <br />Sink (service/badmop/elc.) <br />Backflo�v prevenler <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />Eleclric Gas Olher <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplar,e <br />Gas renge <br />Clothes dryer <br />Ranc�e hood <br />Exhausl fan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby ceritily Ihat I have read and examined this applicalion and know the same to be true and correct. All provisions ot law� and <br />ordinaces governing Ihis lype o( work will be complied wilh whetl�er specified herein or noL The granting of a permit doos iwFpresume <br />to givo authoiity to violate or cancel the provision o( any olher stale or local law rec�ulating consWction or the pedortnance of <br />construction. That I am authorized by lhe owner of this properly to perform the work for which application is made and I comply wilh lhe <br />Stale Contreclors Law 18.27 RCW and 29G.200 WAC. <br />�/ " /�/�� / ��/�� % _ <br />Signature o( OwnedContractor/Authorized Agenl Date <br />