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<br />P�MIT APPLICATI �
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<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 - DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED
<br />SITE ADDRESS PARCEL TAX I.D. # PERMIT #
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<br />LEGAL `LOT NO. BLOCK TRACT
<br />DESC. ��-/�� ! r� ' $ ' 't; � , � , � -, - ;�
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<br />uwrvtrc ADDRE55 CITY/ZIP PHONE
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<br />TENANT NAME CONTACT FOR PERMIT PHONE
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<br />�1.,�)l;�l.� ��.1 � � �i�-�i_ � "��=7�=�;.r l��1���:'-vl l =� �i;i�,��t!'or�_�/%..� -�.�5- _ >; ���L 1
<br />CONTRACTOR ADDRESS CITY/ZIP PHONE
<br />CONTR. LICENSE #
<br />USE OF BUILDING
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<br />WORK DESCRIPTION
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<br />-_. 7 ; �;'rJ�� ._� _�_ ,-; ; . � �,,
<br />NO
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<br />�PLUMBIN
<br />TYPE OF FIXTURE OR ITEM
<br />Toilet
<br />Bathtub
<br />Lavatory (wash basin)
<br />Shower
<br />Kitchen sink & disposai
<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 />Other
<br />HEAT SOURCE
<br />_ Electric �
<br />�
<br />/� CONTRACT PRICE OF WORK
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<br />Other ��" �' " , �'
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<br />,`I-= j�o�'�<;i��� � � /�/� l/ ,%
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<br />NO.
<br />X
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<br />1
<br />ICAL
<br />TYPE OF FIXTURE OR ITEM
<br />A/C — air handling units
<br />Forced air systems
<br />Gas piping
<br />Water heater
<br />Gas fireplace
<br />Gas range
<br />Clothes dryer
<br />Range hood
<br />Exhaustfan
<br />Heat pump
<br />Unit heater
<br />Boiler
<br />Refrigeration
<br />Woodstove
<br />Other
<br />CITY OF EVERETT LOCAL SALES TAX 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 yiolate or cancel the provision of any other state or local law regulating construction or the performance of
<br />construction. hfat Ilam authorized by the owner of this property to perform the work for which application is made and I comply with the
<br />State Conxrac�o�rs aw 18.27 RCW and 296.200 WAC. , �
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<br />%��� � 1 /�"� � � � ' _� � " ,� , �� % � --� , � /"�I
<br />Signature of Owr�er/C ntractor/Authorized Agent Date �� I
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