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SITE ADDF�SS� <br />LEGA � NO. <br />TENANTNAME <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />P�RMIT APPLICATiOrI <br />CITY OF EVERETT NERMIT 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 />�f/11�1 C� �iC <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Ciothes washer <br />Water heater <br />Sink (servicelbarlmopletc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Greasetrap <br />Roof drains <br />Other <br />PARCEL TAX I.D. t� <br />TRACT OR SUBDIVISION N <br />ADDRESS „�y( CITY2IP <br />����..J <br />��,e/ 7-c1 r�.5f" �2.� <br />coNTpCTFORPERM PHONE <br />�S� <br />3 <br />HEAT SOURCE <br />_ Electric _ Gas _ Other <br />U <br />�yS-3xi <br />l�oi� <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FlXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify lhal I have read and examined lhis application and know the same to be Irue and cortect. All provisions of laws and <br />ordinaces governing this type ot work wiil be complied with whelher specified herein or not. The granting of a permit does not presume <br />lo give aulhority to violate or cancel the provision of any other state or local law rogulatlng constructlon or the per(ormance of <br />construction. That I am aulhorized by the owner of this property to perform the work tor which applicaGon is made a�d I comply with the <br />Stale Contractors Law 18.27 RCW and 296200 WAC. <br />� _ .� ., _ _ � 4_.,9 <br />