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1'-�RMIT APPLICATI�JN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, E`JERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />ADDRESS <br />LOT NO. <br />NAME <br />I Ir� <br />PARCEL TAX I.D. # <br />BLOCK 1/ TRACT <br />CONTACT FOR PERMIT <br />PERMIT # <br />jSGb'c� av <br />PHONE <br />��NT��R�`YL�rIJ\Ll..�«11�1� -�R(�x �z�l� tr��ll C��ek�L'�-�\`I�j`.^�� <br />r �`�� �wN��r1-�� �� �IzS�ygf-71a�_ <br />USE OF BUILDING HEAT SOURCE CONTRACT PR^IC�E OF WORK <br />��� 1 _ Eleclric _ Gas _ Olher I��� �^�' w <br />WORK DESCRIPTION <br />�C�, �q� Q�e\\t�b�c: l'1'lc�c,� �F\ �Peti�.�}'�'�S <br />!�c\�, C�� � �\����g �r� P��c�ea'� <br />NO. ( TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service!bar/mop/etc.) <br />Backflow preventer <br />Urinai <br />Drinking Fountain <br />Floor drain <br />Grease Vap <br />Roof drains <br />Other <br />� <br />Mt� <br />TYPE OF F�XTURE OR ITEM <br />A/C — air handling unils <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify lhat I have read and examined !his application and know lhe same l0 6e true and correct. All provisions of laws and <br />ordinaces goveming lhis type of work will be complled wilh whether specified herein or not. The c�ranling of a permit does not presume <br />to give authority to violate or cancel lhe provision of any other state or local law regulating construclion or the per(ormance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I wmply with lhe <br />State Cop(ractors Law 18.27��W and 296.200 WAC. <br />