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PERIIiiIT APPLECATIC�N <br />ClTY OF EVERETT PE�RMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAY. 425-257-CE57 - www.everettwa.org <br />SITE ADDRESS <br />�%�� � <br />LEGAL LOT NO. � <br />TENANTNAME <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />ti�f-�°�(�a �.� O/ 7 <br />BLOCK TRAC7 OR SU50IVISION # <br />CONTAC:T FOR PERMIT <br />�.[�7J� <br />��— <br />PERMIT #,, D/ a— <br />� ��.� - � <br />I E-MAIL <br />CONTRACTOR A�URE55 CITY/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTIGN <br />NO. I TYFE OF FIXTURE OR ITEM17 <br />Toilel <br />Bathlub <br />Lavatory (wash basin) <br />Sho�ver <br />Kilchen sink & disposal <br />Dishwashcr <br />Clolhes washer <br />W aler heater <br />Sink (service/barhnop/elc.) <br />Backtlow prevenler <br />Urinal <br />Diinking Founlain <br />Floor drain <br />Grease t�ap <br />Roof drains <br />Other <br />HEATSOURCE <br />Eleclric Gas Other <br />NO. <br />CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas p�ping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Ran�e hood <br />Exhaustfan <br />Heat pump <br />Unil he2ter <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVEftEI-f LOCAL SALES TAX CODt IS 3105 <br />I hereby ceritify lhat I have iaad and examined lhis applicalion and know the same lo be L•ue and correcl All provisions of lavrs and <br />ordinaces goveming this type of work will be complied �vilh whe�her specitied herein or not. The yran;ing of a permil does not presume <br />to c�ive authorily �o violale or cancel the provision o( any olher stale or local law regulating consWclion or the performance of <br />construction. Thal I am authorized by lhe owner of lhis property lo peiform Ihe work for which applicalion is made and I comply with the <br />Stale Contraciors Law 1R.27 RCW and �96.2D0 WAC. <br />SignaWre of OwnedContractodAuthorized Ac�ent Date <br />