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P�rtMIT APPLICATI(���I <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 CREDR CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />LOT N0. <br />NAME <br />CONTR. UCENSE N <br />USE OF BUILDING <br />WORK DESCRIPTION <br />PARCEL TAX I.D. X <br />�. �- 3 -� <br />BLOCK TRACT � <br />ADDRESS <br />�hW ��era�/ <br />CONTACT FOR PERMIT <br />1 LLL I8'��8 - N:iRA .4vC SL <br />ADDRESS <br />T E L 9�3 Bg <br />I — HEATSOURCE <br />Electric Gas Other <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry Vay <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Fioor drain <br />Grease trap <br />Roof drains <br />Other <br />-oo <br />'il...11 <br />CITY2IP <br />PHONE <br />CONTRACT PRICE OF WORK <br />NO. � TYPE OF FIXiURE OR ITEM <br />A/C — air handling units <br />Forced alr systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas renge <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Bolier <br />Refigeration <br />Woodstave <br />Other <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this application and know the same to be Lve and correct. All provisions of laws and <br />ordinaces governing this rype of work will be complied with whether spec�ed hereln ar noL The grenUnp of a pertnit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulatlng constructlon or the performance of <br />construction. Tha; I am authorized by the owner of this property to pertorm the work for which applicadon fs made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of OwnedContractodAuthonzed Agent ate <br />