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SITE ADDRESS <br />-- ' � / <br />LEGAL LOi N0. <br />DESC. <br />OWNE\� <br />7ENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />PE�M�T APPLICATIOiv <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 />PARCEL TAX I.D. # <br />BLOCK I TRACT <br />ICONTACT FOR PERMIT <br />NDDRESS <br />HEAT SOURCE <br />Eleclric Gas Othcr <br />WORK DESCRIPTION <br />���o1s� ��� <br />NO. I TYPE nF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kilchon sink & disposal <br />Dishwashor <br />Clolhes washer <br />Walor hoaler <br />Sink (servico/barlmop/otc.) <br />BackOow prevenlor <br />Urinal <br />Drinking Fountaln <br />Floor draln <br />Greaso lrap <br />Roof drains <br />Other <br />NO. <br />PERMIT # <br />PNONE <br />CITY2IP PHONE <br />I CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handlin� units <br />Forced alr systoms <br />Gas pipinc� <br />Wator healcr <br />Gas fireplaco <br />Gas rango <br />Clothes dryor <br />Rango hood <br />E�aust fan <br />Healpump <br />Unit hoa�or <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TA7C CODE IS 3105 <br />I hereby corilify that i havo read and ezamined this applicalion and know lhe same to bo Wo and correct. All provlslons of laws and <br />ordinacos c�overning this typo of work will be comFliod wilh whether specified herein or nol. Tho granling of a permil does not presumo <br />lo glvo authority lo violato or cancel the provision of any olher slate or local law rogulating conslructlon or the per(ormance of <br />conslruction. That I am authorized by tho owner of lhis property to perform the work for which application Is mado and I comply with the <br />Slalo Conlractors Law 18.27 RCW and 29�.200 WAC. <br />