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� <br />P�RMIT APPLICATIQN <br />CITY OF EVE�iE7T PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />� I�_ .. �� APPLICATIONS ARE ACCEPTELI FROM 3 AM TO 4 PM <br />SITE A�DRESS PARCEL TA!( I.D. # PERMIT # <br />�. h�,,.a��nn r-,�or�-N ��?��3UC��� 11�0�1 C.CJ ;-ooS <br />LOT <br />DESC. <br />� <br />BLOCK <br />Cou�y Cons+ I�� � <br />i".F�c�i�Fa N z <br />USE Or BUILDING <br />J <br />WORK DESC9IPTION <br />bv�ld �e� <br />BDIVISION # <br />_nn/.,_, <br />CONTACT FO PERMIT <br />�211f11�{� �..��11StS <br />(�p ��X I � <br />V � <br />CITY?IP, PHONE <br />1�5���12 C�r,'��N'SN�137 <br />«�g",�.ya-5�3� <br />61.fA1L (��1 r�l . �'IariS� �� `r �lv. � <br />(�1C�� � ��S.�i I I e <br />qa� �o <br />( 3��'� y5y-5i�� <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric � Gas _, Other � qv / "�v <br />si���le -��i3��y i-�.�clenCe (��rsi�c �I <br />NO. I TVPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink R disposal <br />�ishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />8ack(low prevenier <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Roo` �irains <br />Other _ <br />Nq, � TYPE OF FIXTURE OR ITEM <br />A/C — air handling uni�s <br />T Forced air systems <br />3 Gas piping <br />� Waterheater <br />Gas lireplace <br />G�s range <br />/ Clothes dryer <br />Range hood <br />—�/ Exh3u5ltan <br />Heatpump <br />Unit heater <br />Boiler <br />Relrigeration <br />Woodstove <br />CITY OF EVERETf LOCAL SALES TAX CODE 1S 3105 <br />I hereby ceritify iha[ I have read and examined ihis application and know the same to be true and correcL All provisions of laws and <br />ordinaces goveming this type of work will be complied wi�h whether specified herain or not. The gran�ing of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the pedormance of <br />construction. That I am aulhorized by the owner o( Ihis property to per(orm the work for which application is made and I comply with the <br />c���„ r..��.����.c I ow 1H 97 RCW and 79Fi200 WAC. <br />t'� <br />