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SITE ADDRESS <br />LOT N0. <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 />BLOCK I TRACT OR SUBOIVISION N <br />TENANTNAME CONTACTFORPERMIT PHONE <br />E�NIAIL <br />CONTR. UCENSE M <br />USE OF BUILDING <br />5�—� <br />WORK DESCRIPTION <br />� C.1/� � <br />� W ttix_ 1/ <br />V' f> c'�� <br />NO. � TYPE OF fIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />BackFlow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Rooi drains <br />Other <br />HEATSOURCE <br />Electric Gas Other <br />5 � rb -o� <br />PERMIT � <br />�5'�� <br />� <br />iONE <br />�-12r-z3o-gv� ( <br />CONTRACT PRICE OF WORK <br />NO. � TYPE OF FU(TURE OR ITEM <br />A/C — air hantliing units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas firoplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />RefrigeraUon <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby cerilify thal I have read and examined this applicaGon and know the same to be true and conect. All provisions of laws and <br />ordinaces c�ovorning this type of work wiil be complied with whether specified herein or nol. The granting ot a pertnit does not presume <br />to give authority to violale or cancel lhe provision of any olher slate or local law regulaling constructlon or the perfortnance oi <br />construclion. That I am authorized by the owner of this property lo periorm lhe work tor which application is made a�d I comply with the <br />State,Contractors Lavt18.27 RCW ar1d,2A6.200 WAC. <br />