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SITE DD SS <br />LEGA LOTNO. <br />DESC. <br />OWN--J����lt� <br />i <br />\ <br />TENANT NAME <br />CONTRACTOR <br />CONTR. LICENSE N <br />USE OF BUILDING <br />P�RMIT APPLICATIvN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org g_a s-od <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />PARCEL TAX I.D. �k <br />ICONTACT FOR PERMIT <br />ADDRESS <br />HEAT SOURCE <br />Electric _ •�es _ Other <br />NIORK DESCRIPTI N <br />i �OI�S� hG�(s� <br />NO. I TVPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bafinop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />PHONE <br />CITY2IP PHONE <br />�I CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />Forced air syslems <br />Gas piping <br />Water hea[�r <br />Gas fireplaa� <br />Gas rango <br />Cbthes drver <br />Range hoc,d <br />Exhausl !an <br />� Heat pump <br />Unit heater <br />Boiler <br />Re(rigeration <br />Woodstove <br />Other <br />CITV OF EVERETT LOCAL SALES TAX CODE IS J705 <br />I hereby ceritify that I have read and examined this applicalion and 4.now the same to be lrue and correcL All provisions of laws a�d <br />ordinaces c�oveming this type of work will be complied wilh whelher specified herein or nol The granting of a permit does nol presume <br />to givc aulhority lo violale or canr.el the provision of any olher state or local law regulating construction or lhe performance of <br />construction. Thal I am authorized by the owner of this property to pertorm Ihe work for which application is made and I comply with the <br />Slate Contraclors Law 18.27 RCW and 296.200 WAC. <br />Signature of OwnedContracbdAuthorized Agent Date <br />I�, � �1 _bb <br />