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SITE ADDRESS <br />LOT NO. <br />CONTR. LICENSE t! <br />USE OF BUILDING <br />WORK DESCRIPTION <br />PERMIT APPLICATIUN <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 B AM TO 4 PM <br />PARCEI TAX I.D. # <br />BLOCK I TRACT OR SUBDIVISION p <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes w�asher <br />Waler healer <br />Sink (service/bar/mop/elc.) <br />Backflow prevent��r <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Other <br />�, 20 S t�� !-� � �':?L�; �J C <br />ICONTACT FOR PFRMIT <br />Kl/�l' ..� Q:C1�1 A110 � <br />HEAT SOURCE <br />Electric Gas Other <br /># <br />Vt <br />�(�f ��� ,. . <br />J <br />£ Jb��,r PHONE ` <br />� N{ c , � _ � 7 ��f <br />� u�iSj E-MAIL � '� �� - �' <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC — air handling unils <br />Forced air syslems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust (an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerili(y lhal I have read and examined lhis applicalion and know lhe same to be lrue and correct. All provisions of laws and <br />ordinaces goveminc� Ihis type o( work will be complied with whelher specified herein or nol The granting of a permit does nol presume <br />to give authority lo violale or cancel the provision of any other state or local law regulating conslruclion or lhe performance of <br />construction. Thal I am authorized by the owner et this property to perlorm the �vork for �vhich applicalion is made and I comply with the <br />Slale Contractors Law 18.27 RCW and 29�.200 N'AC. � <br />