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SITE ADDRESS <br />., . <br />LEGA LOT NO. <br />DESC. / a <br />OWNER <br />/ �. . <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE A <br />USE OF BUILDING <br />v�WORK DESC IPTiI <br />F�RMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-885'I — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilot <br />3athlub <br />Lav�tory (wash basin) <br />Sh�.wer <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />TRACT <br />PARCEL TAX I.D. # PERMIT # <br />>�-(3 � �(�� 3o?n )�0� ao�o� <br />POR PERMlT <br />HEATSOURCE <br />� Eleclric _ Gas _ Olher <br />NO. <br />y�s=s3i-� <br />CITY2IP PHONE <br />I CONTRACT PRICE OF WORK <br />TYPE OF FUCTURE 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 />Clalhes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Bailer <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify that I have read and examined lhis application and kncw the same to be lrue and correct. Ail provisions of laws and <br />ordinaces governing lhis l,vpe o� work will be complied with whether specified herein or not. The granting of a pertnil does not presume <br />to give aulhorily lo violale or cancel the provision of any other stale or local law regulaling construction or the pedormance of <br />construclion. Thal I am authorized by lhe owner of this property to perform the work tor which application is made and I comply wilh lhe <br />SEet on ctors Law 18.27 RCW and 296T00 WAC. <br />