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SITE ADDRESS <br />LEGA L� NOOS <br />NAME <br />CONTR. LICENSE It <br />USE OF BUILDING <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVIG� S <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-88 � 0— FAX 425-257-8t357 — www.everettwa.org <br />APpLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br />C <br />S ��- <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />CONTACT FOR PERMIT <br />%rm�-- �drn�� <br />PERMIT # <br />S�a/ yz s-z3g �� x <br />PHONE (j� �8 I (Q � (� <br />i <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Eleclric _ Gas � Other <br />WORK DESCRIPTION � <br />�-�s/�ll G'��s P;p;�� �,� �fu� f�nac� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />Sink (servicelbarhnop/etc.) <br />OackBow preventer <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Greasc trap <br />Roo( drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas pipin� <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be true and correcl. All provisions oi laws and <br />ordinances governing this type of work will be complied with whether specified herein or noL The granting of a permit does not presume <br />to give authoiity lo violale or cancel ihe provision of any other slate or local Iaw reguiating consWction or lhe performance of <br />construdion. That I am authorized by ihe owner of this properly to periorm the work tor which application is made and I comply Kith the <br />Stat� onlr� ors Law 18.27 RCW and 296.200 WAC. <br />� �,.., �t._-,� ��g�Z�I� <br />