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NERMIT APPLICATION <br />CITY OF �VERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - wv✓w.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />o( � C1 /1 a r • <br />LEGAL LOT NO. BLOCI( <br />DESC. <br />OWNER <br />_�J�. � i C{�- n o.V�l. I'� <br />TENANTNAME <br />CONTRACTOR <br />CONTR. UCENSE # � ;,,, n e. �- <br />USE OF BUIL'JING <br />��5r;� <br />WORK DESCRI TION <br />� 1- C�. �G <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Di;hwasher <br />Clolhes washer <br />Waler heater <br />Sink {service/bar/moplelc.) <br />BackOo�,v precenler <br />Urinal <br />_ Orinking Foun�:,in <br />Floor drain <br />_ Grease trap <br />Roof drains <br />Other <br />PARCEL TAX I.D. # <br />T� <br />c <br />A DRES <br />'G ONTACT <br />ADDRESS <br />� � .37 -C�:� <br />PER I__� / <br />�� <br />2S�- <br />� z �, � ��1z� ) �,�-,. �, <br />--•--T Z� � 1�S % . �/%�i <br />PERMIT PHONE <br />HEATSOURCE <br />Eleclric Gas Other <br />CITY/ZIP <br />PHONE <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF fIXTURE OR ITEM <br />WC — air handling unils <br />Forced air syslems <br />Gas piping <br />'�Naler heater <br />Gas fireplace <br />Gas ranye <br />Cbthes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Bailer <br />Refrigeraliun <br />Woodslo�ie <br />CITY OF [VERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I ha��e read and examined lhi, applicalion and know Ihe same to 6e true and wrrecL All provisions of laws ar�d <br />ordinaces goveming this type of work will be complied wilh whelher spocified herein or not. The yranling of a permit does r.ot presume <br />lo give aulhority to violatc or cancel the provision of any other state or local law reguialing conslruction or the performance ol <br />wnsUuclion. Thal I am aulhorized by Ihe owner of lhis property to peAorm lhe worR for which applicalion is made and I comply wilh the <br />Statg� ntraclors Law f 8.27 RCW and 296.200 WAC. <br />_; �%�� �:_ �y- . . �� ��°�- <br />