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SITE ADDRE S <br />� ��,Iti <br />L GA LOT NO. <br />DESC. <br />O ER <br />TENA` NAME � <br />T TO <br />CONTR. LICENSE # <br />U5E OF BUILDING <br />� (��u� <br />WORK DESCRIPTION <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 6 AM TO 4 PM ��( �.—/ p <br />V � i�.�`-� <br />PARCFL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />��' 1 <br />;T FOR PERMIT <br />HEAT SOURCE <br />_ Electric �Gas <br />I�'� � � V� i1�0(� i <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toitet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Oishwasher <br />Clo�hes washer <br />Waler healer <br />Sink (service/barlmopletc.) <br />Backfiow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />Other <br />l\ <br />PHONE <br />CONTRACT PRIGE Vt wurcn <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhausl fan <br />Heat pump <br />Unit heater <br />_ Boiler /( , /� �L <br />Refrigeralion !� V �� <br />Woods ve <br />Oth r ' ��'r <br />—" W �' C—, <br />_ � <br />CITY OF EVERETT LCCAL SALES TAX CODE IS 3705 <br />I hereby certify lhat I have read and examined lhis application and know Ihe same lo be true and correct. All provisions of laws end <br />ordinances governing lhis type of work will be complied wilh whether specified herein or not. The granling of a pertnit does nol presume <br />to give authorily to vidale or cancel the provision of any other slate or local law regulaling construction or lhe perfortnance of <br />conslruction. That I am authorized by the owner of this property lo perform the work for which application is made and I comply with the <br />State Contracrors Law 18.27 RCW and 296.200 WAC. � � <br />ZZ <br />� <br />