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PERM�T APPLICATIU�V <br />CITY OF EVERETT PERMIT SERVI�ES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everet�va.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 Ph' <br />u ��o��s� <br />SITE ADDRESS ;; • � PARCE� J( I.D. # �..pERMIT f U.�. <br />LEGAI LOT NO. <br />DESC. <br />OWNER <br />TENANTNAME <br />CONTRAC�OR <br />CONTR. LICENSE q <br />IJSE OF BUILDING <br />WORK DESCRIPTION <br />�;� � ; <br />�, . �.1._ <br />CONTACT FOR PERMIT <br />ADDRESS <br />HEATSOURCE <br />Eleclric Gas Other <br />� I <br />�I r. 1- _ � � c- `' <br />'1�'" 11 Ci � 1.: l ) ->C-., <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />�alhtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clo�hes washer <br />Waler heater <br />Sink (service/bar/mop/elc.) <br />83ck(low provenler <br />Urinal <br />Drinking Fcunlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />PHONE <br />CITY2IP PHONE <br />I CONTRACT PRICE OF WORK <br />NU. I 7YPE OF FIXTURE OR ITEM <br />A�C — air handling units <br />Forced �ir systems <br />Gas pipir,g <br />Water heater <br />Gas fireplar.e <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhausl fan <br />Heat pump <br />Unit heater <br />Boiler <br />Rofrigeration <br />Woodstove <br />Olher <br />CITY l�F EVERETT LOCAL SALES TA% CODE IS 3705 <br />I hereby ceritify Ihal I have read and examined thie application and know the same lo be true and correcL All provisions of laws and <br />ordinaces �overning t' typu o( work will bA complied wilh whether specified herein or not. The granting of a pormil does not presumo <br />lo pivo aulhorily to iolal or cancel ihe provision of any olher state or local law regulating conslructlon or lhe performance ot <br />construction. TI}rit 1 a�n uthyryzed�y lho owner of this property to paAorm the work for which appllcalion is made and I comply wilh the <br />State CoNraGYors 1.¢Sv 18,2iR(1SN and 296.200 WAC. <br />