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SITE ADDRESS <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />TENANTNANE <br />CONTRACTOR . <br />PEr2MIT APPLICATION <br />CITY OF EVERETT PERMIT SERUICES <br />3200 CEDAR STREET, EVERETT. W� 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />.' <br />- � ��� � ��.. <br />.♦ <br />CONTR. L�CCNSE N <br />j\ ', <br />USE OF BUILDING <br />� � V �� �•-+ <br />WORK DESCRIPTION <br />t. - _ j`i.. � . <br />PARCEL TFJC I.D. # <br />' :�. ;� � <br />TRACT <br />+'� <br />, . � , tl��. <br />PERMIT # <br />:�> C� C C� � C�5 -t �� <br />i Ei�t -'e [T � „ �� � � , . <br />;'�_ .Ji,tc n.i,cr' t" ;,.r: .. :r...�`-(,`�:.,v-l:��qi <br />CONTACT FOR PERMIT PHONE <br />. . , ` i . � .,`J'.� ...;1����1 <br />ADDRESS CITY/ZIP PHONE <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Eledric Gas Other � � � � ._ . " <br />— — ri . <br />; 1 � L , . <br />�'�lZi��'.. . �.,, _ Qrce.t . ln'� �:,'. s� .�V"", r: . •�� <br />.t�-��i' �IC ��1� �1'.�r i,G.S �t� .�.r. ;�. Ce.s� C•�.... <br />� . ' �^ .. f:. � � .J . <br />. ... ' e. wC� Il� �d � �(' T � l" <br />..��.�.. necrun�urni <br />N0. I TYPE � fIXTUR[ OR ITEM <br />Toilel <br />Balh�ub <br />Lavatory (wash basin) <br />Shower <br />Kitclien sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />Sink (servicelbar/moplr:lc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Root drains <br />Olher ' <br />NO. i TYPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />Forced air syslems <br />�_ Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Ran�e hood <br />Exhaustfan <br />Healpump <br />Unit heater <br />BOiIPf <br />Refrigeration <br />Woodstove <br />�_ Other ��.��c.�o� I;i,�p.:,�4E <br />I CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby ceriti(y Ihat I have read and examined lhis applicalion and !:now the same lo be true and wrrecl. All provisions of taws and <br />ordinaces governiny Ihis type of work witl be complied with whelher specifed herein or noL The granlin� of a permil does not presume <br />to give aulhority to violate or cancel the provision ot any other slate or bcal law rec�ulaling construction or ihe peAormance of <br />conslruclion. That I am aulhorized by the owner o( this property lo perform �he work tor which application is made and I comply with the <br />Stat r tors Law 18. 7 RC\ and 29f.200 WAC. <br />�=� _ `� �� `- �2:�.,�s�v-t, <br />,� <br />Z <br />•� c <br />