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SITE ADDRESS <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />� <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUIL�ING <br />�ersor,a � <br />WORK DESCRIPTION <br />PERM(T APPLICAT�ON <br />CITY Or EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />q PARCEL TAX I.D. # <br />d ✓ �. <br />BLOCK TRACT <br />AUURESS CITYIZIP <br />�-o �; zke ? z/"F-K/��f.tl,.- f'�.o..'L� �. <br />CONTACT FOR PEkMIT <br />ADDRESS CIN21P <br />HEATSOURCE I <br />_ Eleclric � Gas _ Other <br />r n s�a %/ �A s� �, �.a` 3., {� r o o», <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />v Lavatory (wash basin) <br />� Shower <br />Kitchen e�ink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbar/mop/etc.) <br />BackOov� preventer <br />Urinal <br />Drnking Fountain <br />� Floor drain <br />Grease trap <br />Roof drains <br />Other <br />� PERMIT# <br />, �„ � —� <br />i <br />PHONE <br />� YCr- 485- l � Y/ <br />PHONE <br />y2s. �s�, a tsY <br />PHONE <br />CONTRACT PR!CE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas ranc�e <br />Cloq��as dryer <br />Rangehood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />ReFrigeration <br />Woadstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerili(y that I hav� read and er.amined :his application and know lhe same lo be true and correcL All provisions of laws and <br />ordi�aces �overning this type of work will bo complied wil'n whether specified herein or noL Th.� granting of a per:nil does not presume <br />to �ive authority to violate or cancel the provision of any other slalo or local law regulating construclion or lhe ped+rmance of <br />co9����an. That I am auU�orized by thc owner of lhis propedy to perform lhe work For which application is made and I comply wiUi the <br />,a8' tc Con�acfors Law 16.27„RCW and 2�6.200 WAC. <br />.p <br />