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j P�t��VIIT APPLICATlG�� <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 �ROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRFSS PARCEL TAX L�. # � PERMIT # <br />��� ��_ ,'�� �_� __ I G ;���- ci <br />LOTNO. I BLOCK <br />DESC. <br />� <br />�/�� �Gc��' S S-"�. � L�_ <br />TEfJRNT N E <br />� / / d" / <br />� . s i �r .,-.� �. � <br />CONTRR.CTOR <br />CONTR. LICENSE # <br />USE OF,�UIL' ING <br />( N `'�`_'— " <br />�I�I�77:1 <br />TRACT <br />CONTACT FOR PERMIT <br />ADDRESS <br />�L L4��CC9%`1.� <br />T / <br />NO. I TYPE OF FIXTURE OR I7EM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/badmop/elc.) <br />Backfluw preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />HEATSOURCE <br />Electric Gas Other <br />NO. <br />PHONE <br />CITYIZIP PHONE <br />CONTRACT PRICE OF WORK <br />�J_ � �, .� <br />. <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handliny unils <br />Forced air syslems <br />Gas piping <br />W aler heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Ranc�e hood <br />Exhaustfan <br />Heat pump <br />Unit haater <br />Boiler <br />Rei�iceralion <br />N':.;: 'slove <br />Glher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this applicalion and know the same lo be true and correct. All provisions of la�es and <br />ordinaces governing this type of work will be complied wilh whelher speciled herein or not. The granting of a permit does not presume <br />to give aulhority lo violale or cancel the provision of any other state or local law regulating construction or the performance o( <br />construclion. That I am aulhorized by lhe owner o( this property to perfurm the work for which application is made and I comply with the <br />Sla,e Contrectors Law 18.27 RCW and 296.200 WAC. <br />SignaWre of Owner/Contractor/Aulhorized Agent Date <br />