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PERMIT APPLICATION <br />CITY OF �VERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evermttwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITEADDRESS.3.��..Z.Z�cnthurJ FIV� <br />LOT NO. <br />. <br />�rvir.n�ii�/�n 1, <br />�-% � i / c;V / � �l✓ <br />)NTR. LICENSE # <br />USE OF BUILDING <br />� / <br />WORK DESCRIPTION <br />BLOCK <br />j�e� Fu,��c,� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavalory (wash basin) <br />Showcr <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service!badmop/etc.) <br />Back(low prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other _ <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />CONTACT FOR PERMIT <br />HEATSOURCE <br />_ Electric �Gas _ Other <br />,r.a <br />! D —b�_O� <br />PEFMIT # <br />1'�'t�lc'�— O �2 <br />���7 -,(.7Y-/'�C-i ..0 <br />PHONE <br />E-MAIL <br />PHONE <br />z�� a�o ��Py -730, <br />CONTRACT PRICE OF WORK <br />� '' n <br />� ; n i. �- <br />TY�E OF FIXTURE OR ITEhi <br />A�C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Ranye hood <br />Exhaust fan <br />Hzat pump <br />Unit healer <br />Boiler <br />Retrigeralion <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE �5 3105 <br />I hereby ceritify Ihat I have read and examined this application and kno�v lhe same lo be true and wrrect. All provisions of laws and <br />ordinaces goveminy Ihis type of work will be complied wilh v�helher specified herein or nol. The granting of a permit does not presume <br />lc give authority to violate ur cancel the p�ovision of any other stale or local law �egulaling consWclion or the per(ormance of <br />construction. That I am aul ��rized by lhe owner o( lhis property lo perform the work f�r which applicalion is made and I comply wilh the <br />