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SITE ADDRESS <br />/ <br />LOT NO. <br />Pt�IVIIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 4�5-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 6�- I 6-0 6 <br />PARCEL TAX I.D. if <br />BLOCK I TRACT <br />IC.ONTAGT FOR PERMIT <br />/ i'�LY/il Nil CN �f <br />CONTRACTOR ,�f��`�� �/ __,(% ��NS�rµA,�QPRESS , p <br />� � i�czv.� %� !� l Tvrr f �1 <br />CONTR.LICENSEfI / ���M r/ �` <br />�l L L <br />USE OF 9UILOING <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (sorvice/bar/mopletc.) <br />BackOow prevenler <br />Urinat <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Roof drains <br />Olh,r <br />7J <br />HEAT <br />Electric ,�Gas _ Other <br />� <br />PEpRMIT tF <br />I ��DO�'d�� <br />PHONE <br />C�TY21P PHONE <br />iugfoy� !t/A <br />PRICE OF WORK <br />�� <br />TYPE OF FU(TURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas ranpe <br />Clolhes dryer <br />Range hood <br />Exhaust /an <br />Hoat pump <br />Unit healer <br />Bol�er <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />I hereby ceritify thal I have read and examined this application and know the same to be lrue and correcl. All provisions of laws and <br />ordinaces govoming lhis rype of work will be complied with whether specified herein or not. Tho grantlng of a pertnit does oot presume <br />lo giv3 aclhority to violale or cancel lho provision of any olher slate or local law regulaGng construclfon or the pedortnance of <br />conslruclion. That I am aulhorizod'bptha"owrtQGot lhis property lo perform the work for whlch appllcalian is made and I comply wilh the <br />Stale /C�ontra rs-Lav�i 6�f00 WAC. <br />/ � — ��— (� -a?�Oti <br />