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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.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRE55 / ,� Sw�J-�' <br />�r <br />LOT NO. I BLOCK � TRACT <br />DESC, <br />PARCEL TAX I.D. # <br />�UJIl ( E , �NI�I�T��C�MIT �!^_(�ZC�H\N�2.�_ <br />LX� <br />CONTRACTOR. ADDR65S � CITY2IP PHONE <br />�eY�7.:���-�- �-�vsJ��y�1ti� 2Gc� �y`-"-'i� ��.� Gl"�v�Uu�� J�,U'�(2�(' ( <br />coNrR. uceNs=-n�,u��—�t��3�3 4� F `�"�7'� _ <br />USE OF DUILDIN <br />/ <br />C� � v� � <br />WORK DESCRIPTION <br />�C�ir"� ��u.nc� J � <br />��ti5-���� ( <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />CON7!;i�G i <br />�����ss s,�� ����,;-��,�1 �u��� <br />C ��.l'�l sk-l�'1 �� �o I� 5l � <br />_..._ � �— ..�, <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtu6 <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 />6ackflc��r preventer <br />Urinal <br />Drinking Fountain <br />Flocr drain <br />Grease trap <br />Roof drains <br />Olher <br />5 � ��1 <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gasrange <br />Clo!hes dryer <br />Range hood <br />Exhaust `an <br />Neatpump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />WORK <br />I hereby ceriti'y that I have read and exam�ned this applicalion and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied wilh whether specified herein or not The granting af a permit does no[ presume <br />to give authority to violate or cancei the provision of any other stale or local law regulating consWction or the performance of <br />consiruction. That I am authonzed by the owner of ihis property to perfortn the work for which applicaiion is made and I comply with lhe <br />Slate Contractors Law 18.27�2CW and 296.200 WAC. <br />( j c,z,Q � � �� � �� <br />Signature of U�vnedCo t2ctod uthorized Agent Date d-)C <br />� <br />