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SITE A�DDR S <br />LE �L / �LOT NO. <br />DESC. � <br />S/<���� <br />PERMIT APPLl�ATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />42�-257-8810 — FAX 425-257-8857 — wv✓w.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />o�l:� 9 i���� o� �o> <br />TRACT OR SUBDIVISION # <br /># '/ <br />r%/ Y _ <br />CITY/ZIP PHONE ' <br />TENANT NAME CONTACT FOR PERM1IIT PHONE � <br />I <br />E-MAIL I <br />CONTRACTOR ADDRESS CITY2IP—�HONE I <br />CONTR. LICENSE # O���J I <br />USE OF 6UILDING I HEAT SOURCE I CONTRACT PRICE OP WORK I <br />WORK DESCRIPTION <br />1i �J�M. J ./) IG�� <br />Y.1 <br />� <br />NO. I TYPE OF FIXTURE OR ITEM <br />� — <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes w2sher <br />Water he2ler <br />Sink (service/bar/mop(efc.) <br />6ack0ow prevenler <br />Urinal <br />Drinkiny Fountain <br />t=loor drain <br />Grease trap <br />Roof drains <br />Olher _ <br />_ Eleclric _ Gas _ Other <br />NO. <br />rvi <br />NPE OF FIXTURE OR ITEh1 <br />A/C - air handlin� units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Ranan hood <br />Exhe�stfan <br />Heatpump <br />Unit heater <br />Boiler <br />Rofrigeretion <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9705 <br />I hereby ceritify that I have read and examined Uiis applicalion and know the same to be true and correol. All provisions of laws and <br />ordinaces goveming this lype of work will he complied with whether specified herein or not. Th� granlin9 0� a permit does not presume <br />to give aulhonly lo violate or cancel the provision of any other slate or local law regulating consWction o� the performance o( <br />conslruclion. Thal I am authocized by thr, owner of thls property lo per(orm Ihe work (or which applicalion is made and I comply with the <br />Slale Conlraclors Law 1827 RCW and 296.200 WAC. <br />Signalure o( Owner/ConlrecloNAuthorized Agent Date <br />