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SITE ADDRESS <br />LEGA �OT NO. <br />DESC. <br />OWNER <br />� <br />TENANT NAME <br />�RMIT APPLICATI�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 1 PM <br />PARCEL TAX I.D. N <br />BLOCK I TRACT OR SUBDIVISION / <br />CONTACT FOR PERMIT <br />iZ.4�117�/ �,lal <br />L�Nt���{ S� � <br />CONTR. LICENSE M <br />USE OF EUILDING <br />� <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Cbthes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />�-c� <br />�ol - 3� <br />PHONE �C'- a�0 <br />S`�W v�loo� <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Electric � Gas _ Other <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 fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhausl fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby ceritify that I have read and examined this application and know lhe same lo be lrue and correcl. All provisions of laws and <br />ordinaces goveming this lype o( work will be complied with whelher specified herein or not. The granling of a permit does not presume <br />to give authority to violate or cancel the provision oi any other state or local law regulating consWclion or the periortnance of <br />construction. That I am authorized by lhe owner of ihis property to perform the work for which applicalion is made and 1 comply with the <br />Stale ConVactors Law 18,27 R�W and 296.200 WAC. <br />