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PEaZMIT APPLICATIO�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, lNA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CRtDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />��— Z S <br />LEGAL LOT N0. <br />DESC. <br />OWNF.R �� <br />ii � <br />�� � <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />S ✓��� <br />WORK DESCRIPTION <br />J � �-�—_— <br />BLOCK TRACT <br />� <br />ADDR[ <br />„�j ��2 � a�C�,/ <br />Ju� �-e�� <br />PARCEL TAX I.D. # PERMIT # <br />MU`1cYi -Oi�i <br />; CITYr'IP PHONE ���— <br />� 2 S /�l �e.., C�.v-p �-ens"� Z 2 3-'7 <br />CONTACT FOR PERMIT <br />ADDRE55 <br />HEATSOURCE <br />_ Electric _ Gas _ _ Olher <br />� � -��, �;�. �?,�r��:�t G-�c � <br />c <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />C�othes washer <br />Laundry tray <br />Sink (service/bar/mop/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 />A/C — air handling units <br />1_ Forcad air systems <br />1_ Gas piping <br />1_ Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiter <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces ggy_eming this type of work wiil be complied with �vhether specified herein or not. The granting of a permit does not presume <br />to giv u�'�onty� violate or cancel the provision of any other state or lor,al law regulating construction or the pe.rformsnce of <br />const ction. That am horized by the oivner of lhis property to perform ihe work for which application is made and I comply with the <br />State C tor��aw 1 27 RCW and 96.200 WAC. �/Z �/ � <br />/ <br />