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�tRMIT APPLICATlC�N <br />CITY OF Ei/ERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FF,X 425-257-8857 - www.eve; ettwa.org <br />APPLIGATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />� 3 / /,ou%�// /� � <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF 9UILDING <br />WORK DESCRIPTION <br />� <br />L��° <br />PARCEL TAX I.D. # <br />,�3%� 1��P/%2�✓ f�e� <br />CONTACT FOR PERMIT <br />ADDRESS CITY2IP <br />HEAT SOURCE <br />_ Electric � Gas _ Olher <br />y <br />%i✓5 �� � <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/elc.) <br />i Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />4� -� ��C� <br />PEI2MIT # <br />nno�oa-o i� <br />PHONE <br />�� Q'��D3 <br />PHONE L��Y �7>7'�Y�.Y <br />PHONE <br />GONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE UR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas rango <br />Clolhes dryer <br />Range hood <br />[?chaust fan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVFiRETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined lhis aFplication and know the same to be true and correct. All provisions of laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or not. Tho granting of a permit does nol presume <br />to give authoriry to violate or cancel the p. vision ot any other state or local law regulaling conslruction or the pedormance of <br />construction. That I am authorize by .vner of this property to perform the work for which application is made and I comply wilh the <br />Stale Cont o L 18.27 96200 WP.C. <br />%/�.^-� � � _ � % �� <br />Signature of Owrer/Contractor/Aulhonzed Agent Date <br />