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PE�kM[,f A?PLfCAYICIIV <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 FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />Lv� • <br />LEGAL LOTNO. <br />DESC. <br />OW NER <br />�SSo <br />TENANTNAME <br />CUIJTRACTOR <br />CONTR. LICENS[ # �� <br />�G:G�� � i7. � �, <br />USE OF BUILDING <br />N;ORK DESCRIP'fION <br />NO. � T: FE OF FIXTURE OR ITEd1 <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Sho�ver <br />Kil�hen sink & disposal <br />Dishwasher <br />Cbthes :vasher <br />Water heater <br />Sink (service/bar/mop/etc.; <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />PARCEL TAX I.D, il <br />TRACT <br />C7NTACT FOR PERMIT <br />ADDRESS <br />HEATSOURCE <br />Elec;ric Gas Other <br />/ �� 06 <br />P• MIT# <br />�G� <br />PHONE <br />CITY/ZIP PHONE <br />� CONTRACT PFtICE OF WORK <br />NO. j TYPE 0� FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pwnp <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />i hereby cerilify lhat I have read and examined this applicalion and know lhe same to be true and correct. All provisions ot laws and <br />ordinaces governing this type o4 work ill be complied with whelher specifed herein or not. The granting of a permil does not p�esume <br />lo give aut ority to violale or atdncel th . provision of any other state or local law regulating construction or the performance of <br />consiruc on That���m th �ed oy he owner of Ihis propeAy to perform the work for which application is made and I comply with the <br />Slato C, tra tors w 1 2 CW d 296.200 WAC. <br />