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PE.�tMIT APPLIC�4TIO�J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, W/, 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACC[PTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS I PARCEL TAX I.D. iF t;�P\ERMI i# � <br />' . . ...�....� nn., �.n�.��_��...i t �OnriGln�o_rinn I I J l`,' J 3—CZ%a'� <br />LOT N0. I BLOCK <br />1T AME <br />UC��L"� <br />TR4CT <br />CONTACTFOR <br />,��i, <br />C TRACTOR ' AI)DRESS � � CITY2!P <br />�ureall �'qu,,omr-,'+�-- / ��7 /�� y �� �r7ai <br />CONTR. LICENSE # <br />USE OF BUILOING <br />,U � <br />WORK DESCRIPTION <br />,�e/na /� �i a� <br />%o� <br />PHONE <br />PHONE <br />�a a�L <br />HEAT SOURCE CON7RACT PRIGE oF woRK <br />_ Electric _ Gas _ Other <br />/,' <br />��i� Dy- o s � <br />PLUMBING ; MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Oishwasher <br />Clothes washer <br />l.aundry tray <br />Sink (service/bar/mop/e!c.) <br />Backflow preventer <br />Urinal <br />Drinkin9 Fountain <br />Floor drain <br />Grease trap <br />Ro.�f drains <br />Othar _ <br />NO. I TYPE OF PIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas rangP <br />Clothes �Jryer <br />Rangeh�od <br />Exhaust .`an <br />Heat purr.o <br />Unit heater <br />Boiier <br />Refrigeration <br />Woodstove <br />Other <br />CI1Y OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby cerili(y �hat I have read and examined this applicaGon and know tha same to be true and correct. All provisions of laws and <br />ordinaces gov� :mg this type of work will be complied with whether specified her�in or not. The granting of a permit does not presume <br />to give autho• .� to violate or cancel the provision of any other state or lucal law regulating construction or the perfortnance of <br />constructir � hat I am authorized by the owner of this property lo perform the work for which application is made and I comply with the <br />Strie C�� . tors Law j8c27�f2CW and 296.200 WAC. <br />