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PE..�MIT APPLICATIG�J <br />CITY OF EVERETT PERMIT S�RVICES <br />3200 CEDAR STREET, EVERE7T, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />/ <br />4 _ g—os <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />,�/ � � �,; <br />LEGAL LOT NO. <br />��t::/.�'�/1'�� % <br />BLOCK <br />TRACT <br />PARCEL( TAX I.D. # PER)MIT # <br />% J� 'f' % Lr/ 1!5 !"i i ( G.�iGG �/ ( � � <br />�f+-�� i � ,�n,i �l %/. � �� G��I��vHf�,�,-_i� i D/�_ �' s�2 -7c.-�G7 <br />TENANT NP.ME CONTACT FOR PERMIT PHONE <br />CONTRACTOR C_1�'p: ; <br />CONTR. l.ICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. <br />! ,h _> c AD�RESS <br />� <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry lray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />HEATSOURCE <br />�% Electric _ Gas _ Other <br />NO. <br />CIlY21P PHONE �-Fi;%- �'i:3�` <br />CONTR.4CT PRICE OF WORK <br />=� .:.i.:.�� <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Heat pump <br />Unit heater <br />Boiler <br />Re(ngeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />I hereby ceritify lhat I have read and examined lhis application and know the same to be true and correcL All provisions of laws and <br />ordinaces governing this type of work will 6e complied with whether specified herein or nc:. The granting of a permit does not presume <br />to give authority to violale or cancel the provision of any other stale or local law regulating construction or the performance of <br />construclion. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Conlrectors�Law 18.27 RCW an�P96 20� <br />i <br />�:• _ � <br />�i.'��;1,Cr / �—��� <br />