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P��.ZMIY APPLICATIO�� <br />CITY OF EVERETT PERMIT SERVIGES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CAROS ARE NOT ACCEPTED <br />SITE ADDRE <br />�" 3 <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />�y � <br />TENANTNAME <br />PARCEL TAX I.D. # <br />� � t� <br />BLOCK TRACT <br />ia � ��/ <br />� CONTACT fi R PERMIT <br />CONTRACTOR'/�,aq�j�o��/��� P/1I. <br />rin�, <br />CONTR. LICENSE # <br />� <br />USE Of BU!LDING <br />WORK DESCRIPTION <br />NO• I TYPE OF FIXTURE OR ITEM <br />Toilet <br />� Ba�htub <br />Lavatory (wash basin) <br />Shower <br />1_ Kilchen sink E disposal <br />Dishwasher <br />/ Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trep <br />Roof drains <br />Other <br />t 'j A��ftE55 CITY2IP <br />3'-r � � L,', �m�t�, <br />5 .� ,�� - 5' � <br />— HEATSOURCE I <br />ElecMc Gas Other <br /># <br />J U " <br />PHONE <br />PHONE <br />�5 S- z 9`C� <br />/ <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fi•eplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrige2tion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />; I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />� ordinaces governing this type ot work will be complied with whether specified herein er not. The granting of a permit does not presume <br />�, to give aulhority to violate or cancel the provision of any other state or local law regulating construction or the peAormance of <br />� construction. That i am authorized by the owner of Uiis preperty to perform the work for which application is made and I comply with the <br />' State Contractor� Law 182i RCW and 296.200 WAC. <br />' � / <br />j ' <br />I _ � `" i ,�•y=,.= _� �i � Z C �- O y' <br />