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PLrtMIT APPLICATIG�� <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 CREDIT C.4.� S ARE NOT ACCEPTED <br />SIT� C �� / 9��^ . � , � I PARCELTAXI.D.# i ��T��� �6�� <br />l� <br />LOT N0. <br />DESC. <br />u .� <br />CONTRACTOR <br />CONTR. LICENSE # l /���_� <br />(/ <br />USE OF BUILDING <br />S�i'"�Yz <br />WORK DESCRIPTION <br />TRACT <br />ICONTACT POR PERMIT <br />ADDRESS <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />��� -`"-� /���"""C <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />= Kitchen sink 8 disposal <br />� Dishwasher <br />� Ciothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. <br />CITYIZIP <br />PHONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />TYPE OF FIl(TURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas flreplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work �.vill be complied with whether specified herein or noL The g2nUng of a pertnit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulatlng construction or the performance of <br />construction. That I am au orized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 1 27 RCW and 296.200 WAC. <br />� i�_� / ��'///�H� <br />