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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 <br />SITE ADDRESS �� I <br />p0 �� W EVE i <br />LEGA �1p��J0�P E �OC TR Cl <br />D[SC. EG � , 5�1 � ci o <br />S �G Y' - 5 <br />M�DE�N Bulc.DiN6 S�{S1�qutS °t9�3 <br />PARCEL TAX I.D. p <br />� <br />TENANT NAME CONTACT FOR PERMIT <br />�VE¢�1�' GDµMUN t[Y G�LL�G-�. ��A WII,D�� , E <br />-�ns se�— <br />CONTR. LICENSE p • ' '���L ��O �// � <br />U <br />USE OF <br />�HEATSOURCE <br />GE <br />� Eleciric _ Gas _ Other <br />WORK DESCRIPTION <br />-(�MP�Kh1� �o'�ThB�.E ��� uN �r. <br />U�J lT lS L�Q�'�D 'C� T� � Go�-l.Ef�E • <br />N0. � TYPE OF FlXTURE OR ITEM <br />Toilet <br />�athtub <br />Lavatory (wash basin) <br />� Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (serviceroadmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease irap <br />Rool drains <br />Olher <br /># <br />so3-149-4q� <br />PHONE <br />CONTRACT PHICE OF WORK <br />��Io7-o�8) <br />N0. � TYPE OF FIXTURE OR ITEM <br />A/C - air hand!ing units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Ezhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Retrigeration <br />Woodstove <br />Other _ <br />CITY OF EVEHETT LOCAL SALES TA7f CODE IS 3705 <br />I hereby ceritity that I have read and examined this application and know Ihe same to be Irue and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specitied herein or not. The granting of a pennit does not presume <br />to give aulhorily to violate or cancel �he provision ol any other state or �ocal law regulating conslruction or the pertormance of <br />cons�ruction. That I am authorized by ihe owner of this propeity �o perform the work for which application is made and 1 comply wilh Ihe <br />Stat�.spn�racrors Law 1827 RCW and 29G.200 WAC. <br />I/ <br />2 <br />