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$ITE ADDRESS <br />/ � �L� <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />�� � � I I � <br />TENANTNAME <br />CONTRACTOR i�U- <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />P� �kMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <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 <br />PARCEL TAX I.D. # <br />I�,� � <br />'BLOCK TRACT <br />ADDRESS CITY2IP <br />� Q ��1�� <br />CONTACT FOR PERMIT <br />� ADDRESS CITY2IP <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lava�ory (wash basin) <br />Sho�ver <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />W ater heater <br />Sink (servicclbar/mop/elc.) <br />BacY.11ow preventer <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />PERMIT # <br />PHONE <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangc hood <br />Exhaust fan <br />Heal pump <br />Unit healer <br />Roiler <br />Refrigeralion <br />Woodslove <br />Olher_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritity lhal I have read and examined lhis application and know lhe same to be lrue and correcL All provisions of laws and <br />ordinaces goveming this type of work will be complied wilh �vhether specified herein or not. The granting of a permil uoes �:�! oresume <br />to give authority to violale or cancel lhe provision of any other slate or local law regulating construction or the pedormance of <br />conslruction. Thal I am aulhorized by the owner of this properly to per(orm the work for which application is made and I comply ��ilh Ihe <br />State Conlr�clors Law 18.27 RCW and 296200 WAC. <br />I/�p �/ '�j� � � (�� / <br />Y/l� �1tt1,(t�—_V.�-tu.l9�"rr �'L�'lg'i_)1j <br />