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PtRMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — �nnvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SI?E ADDRESS ' - <br />� 3 �,, ,, �, <br />LEGAL LOT N0. <br />DESC. <br />OWNER <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE il � � <br />USE OF BUILDING <br />BLOCK <br />PARCEL TAX I.D. S <br />TRACT OR SUBDIVISION # <br />CONTACT FOR PERIAIT <br />AUDRF S <br />P �� �� <br />HEATSOURCE <br />Eleciric Gas Other <br />WORK DESCRIPTION -��- <br />d���ll� ,�'el��Cr <br />PLUMBING <br />N0. I TYPE OF FIXTUR[ OR ITEM <br />Toilcl <br />6alhtub <br />_ Lavalury (was'� basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />W ster heater <br />Sink (serviceNadmop(etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Roof drams <br />Olher <br />6 —1� ��'i <br />PERMIT # <br />CITY/ZIP PHONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />FUC — air handling unils <br />Forced air systems <br />Gas piping <br />W aler healer <br />Gas fireplace <br />Gas range <br />Clothes drycr <br />Ranc�e hood <br />Exhaust (an <br />Heat pump <br />Unit hcater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Olher <br />CI11 OF EVERETT I,OCAL SALES TAX CODE IS 3105 <br />I I hereby ceritify Ihal I have read �nd examined this applicatinn and kno�v the same to be true and correcl All provisions of laws �nd <br />iordinaces governing lhis type o( wodc will be complied wilh whelher specified herein or not. The granting of a permit does not presume <br />l� give aulhority lo violale or cancel ;he provision of any other state or Wcal law regulaling construclion or Ihe perlormance of <br />consiruction. That I am aulhorized by the owner of tliis property lo pe�iorm lhe work tor which application is made and I comply wilh the <br />i Slal� Conlrecto�rs Law 18.27 RC�h' and 296.200 WAC. <br />r p <br />�,"/ �, �( s.---�✓ �' I r i � <br />I $?�nalu�Owner/ ntF todFwthonzed Agent Date <br />�� <br />