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SITE ADDktSS <br />�cRMIT APPLICATIUN <br />CITY OF EVERE7T PERM�T SERVIC�S <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257• 8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLIC:ATIONS ARE ACCEPTED FROM 9 AM TO 4 PM <br />PARCEL TAX I.D. A <br />-7 --S'--a� <br />y`� �MY1I.L! �� I1 �bC:i�d I\ .� �`d�l �� S(i�i . ��• != l�C✓C.� � ��V H' ( O� D J _ <br />TCIii�NT NAME <br />CONTRACTOR <br />CONTR. Li :ENSE #�G(��JC� <br />USE OF BUILDING <br />WORK DESCRIPTION _ <br />���� ad����� <br />:�i.r� <br />NO. I TYPE OF FI%TURE GR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />DishwashPr <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Backllow prevenler <br />Urinal <br />� Drinking Founlain <br />Floor drain <br />Grease trap <br />Roo( aiains <br />� Olher <br />CONTACT FOR PERMIT " <br />A�DRESS CITY2IP <br />— HEATSOURCE I <br />Electric _ Gas Olher <br />" PHONE <br />S 3S3 �//6 <br />PHONE <br />CONTRACT PRICE OF WORK <br />�qu� cr� ,Bl�/O -US� <br />�i <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas pipinr� <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />I-leat pump <br />Unil heater <br />Boiler <br />Refrigeralion <br />Woodsiuve <br />CITY OF FVERL'TT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify Ihat I have read and examined lhis zpplication and know lhe same to be true and correcL All provisions of laws and <br />onjinaces c�overning lhis type of work will be compliad wilh whelher spedfed tierein or noL The granting oF a permit does not presume <br />lo yive aulhoriry to violale or cancel the provision of any other slale or loca I� regulaling r,onstruction or the porformance of <br />conslruc�aq. That I am au�horized by Ihe owner of this propeAy to pertorm the wor� for which applicalion is made and 1 comply with the <br />Stale Cprit4aytors Law 18.i7 �tCN{�and 29G.200';VAC. <br />