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SITE ADDRESS <br />NO. <br />TENANT NAME <br />CONTR, LICENSE M <br />USE OF BUILDING <br />WORK DESCRIPTION <br />CQ <br />� <br />PERMIT 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. N <br />,�Ig�zc�l <br />BLOCK TRACT OR SUBDIVISION N <br />z� �;�- %���'e- d' ' 3 6°��-bl 98�° i <br />I CONTACT FOR PERMIT P� <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Levatory (wash basin) <br />Shower <br />Kitchen sink & disposel <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbar/mopletc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEAT SOURCE <br />�/ Electric _ Gas _ Other <br />la-..o�.,l� <br />PERMIT t <br />.if25-Z63� id� <br />CONTRACT PRICE OF WORK <br />��000 <br />NO. I TYPE OF FIXTURE OR REM <br />A/C — air handling units <br />Forced air eystems <br />Gas piping <br />Water heater <br />Gasfireplace <br />Ges renge <br />Clothes dryer <br />Renge hood <br />Exheust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 5106 <br />I hereby certify thet I have read and ezamined this epplicalion and know ihe same lo be true and corted• l�II provisiona o( lews end <br />ordinances goveming this type at work wfll be complied with whether specified herein or not. The prendnp oi a pertnR does not prosume <br />to give authority lo vidate or cancel the provision of any other st`0 o��ltlew ��for� id� epplicaUon �s�mada�� �py �� <br />wnstruction. That I em authorized by the owner af this property pe <br />s�seo r.��trwr.tors Lew 18.27 RCW and 296.200 WAC. <br />