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SITE <br />f�tRMIT APPLICATIl.N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />� %/�i� V/� <br />� <br />LOT NO. BLOCK <br />NAME <br />CONTRACTOR �� �cL� <br />CONTR. LICENSE N <br />USE OF BUILDING <br />WORK DES RIPTION <br />��� � <br />TRACT <br />PARCEL TAX I.D. � <br />M <br />� ltJ . �2 tG&. �bS� � 6�6� <br />CONTACTFORPERMIT <br />,�—�� -�i�iG�/''' <br />ADDRESS CITY2IP <br />— HEATEOURCE I <br />Electric Gas Other <br />PHONE <br />o�DG �S�o ( 3oY <br />PHONE <br />CONTRACT PRICE OF WORK <br />��� � <br />�r"kk..e- l!%�,✓ ��kn�s. �e uns+a�it �� lir(►�al� � � ��ves5. <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhlub <br />Lavatory (wash basin) <br />Shownr <br />Ki:chen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry lray <br />Sink (service(bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />NO. I TYPE OF FU(TURE OR ITEM <br />NC - aIr handltng units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralfon <br />Woodstove <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby ceriGfy that I h�ve read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be comptied with whether specified herein or not. The granling of a permit does not presume <br />to give authoriry to violate or cancel the provision of any other state or local law regulaUng construction or the performance of <br />construction. That I am aulhorized by lhe owner of lhis pmperty to pertortn the work for which applicadon is made and I comply with the <br />State Co���ycj)!i7 RC�pL�nd 296,200 WAC. /, <br />