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SITE <br />LOT NO. <br />NAME <br />CONTR. LICENSE p <br />USE OF BUILDING <br />WORK �ESCRIPTION <br />NO. <br />PERMIT AQPLICATIO�J <br />CITY OF EVER�TT PERMIT SERVICES <br />3200 CEDAR STREET, EVE�ETT, W,4 98201 <br />425-�57-88 i 0— FAX 425-257-8857 — wv✓w.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />BLOCK I TRACT (�k SUBDIVISION # <br />P�g RMIT # <br />( �jv i-UO <br />ADDRESS CITY/ZIP PHONE <br />� /l�i�ine � <br />CONTACT FOR PERMIT <br />!' � <br />f/�V <br />NG <br />TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sinA & disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (service/badmoplelc.) <br />Backflow preventer <br />Urinal <br />Drinkiny Founlain <br />Floor drain <br />Grease Irep <br />Roof drains <br />Olher CC� SS_� `� ,'� Cc (,�� C� �f <br />. � <br />SOURCE <br />� Electric � Gas _ Ofher <br />PHONE <br />CONTRACT PRICt OF WORK <br />N0. I TYPE OF FI7(TURE OR ITEM <br />AIC — air handliny uniis <br />Forced air syslems <br />Gas pipinc� <br />Water healer <br />Gas tireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhausl (an <br />Heal pump <br />Unit healer <br />Boiler <br />Refrigeraticn <br />Woodstove <br />Olher _ <br />CIN OF EVERETT IOCAL SALES TNC CODE IS 3105 <br />I hereby cerili(y thal I have read and examined this application and M.now the same to be true and corrert. All provisions o( lak•s and <br />ordinaces goveming lhis type of work �•rill be complied with whether specified herein or not. The granling of a permit does not presume <br />to give authority to violate or cancel lhe provision o( any oUier state or local law regulating conslruclion or Ihe performance of <br />conslructio/i,�That � am authorized by the owner o( this property lo perform the work for which application is made and I r.omply with lhe <br />Siate�coafractors Law it�?27 RCW and'29ti.'L00 \'JAC. <br />` 7O � `. <br />7 I <br />Dzt <br />