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SITE ADDRESS
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<br />LEGAL LOT NO.
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<br />I�rRMIT APPLICATICIN
<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 ACCEPTF� FROM S AM TO 4 PM
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<br />CONTR. LICENSE #
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<br />PARCEL TAX I.D. # PERMIT #
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<br />TRACT OR SUBDIVISION #
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<br />ADDRESS CITYIZIP PHONE
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<br />CONTACTFORPERMIT PHONE
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<br />HEATSOURCE
<br />_ Electric � Gas _ Other
<br />CONTRACT PRICE OF WORK
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<br />WORK DESCRIPTION
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<br />NO. I TYPE OF FIXTURE OR ITEM
<br />TpilCl
<br />Balhtub
<br />Lavalory (wash basin)
<br />Shower
<br />Kilchen sink & disposal
<br />Dishwasher
<br />Clothes washer
<br />W ater heater
<br />Sink (service/bar/mop/elc.)
<br />Backflow preventer
<br />Urinal
<br />Drinking Fountain
<br />Floor drain
<br />Grease trep
<br />Roof drains
<br />Other '- '
<br />NO.
<br />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 />Gas range
<br />Clothes dryer
<br />Range hood
<br />Exhaustran
<br />Heat pump
<br />Unit heater
<br />Bailer
<br />Refrigeretion
<br />Woodstove
<br />Other
<br />CITY OF EVERETT LOCAL SALES TAl( CODE IS 3105
<br />I hereby cerili(y thal 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 rype o( work will be complied with whether specifed herein or not. The granting of a permit does nol presume
<br />to give a�Cionty to vi te or cancel the provision of any other slale or local law regulating consiruction or the peAormance of
<br />conslruction. Tha a aulhorized by the owner of this property to perform the work for which applica!ion is made and I wmply with the
<br />State Con s yy18.27�CW �296.�00 WAC.
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