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FcRMIT APPLICATIuN <br />6 .a-y-o� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 � �d <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org /�� �� 5 <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTEQ <br />SITE ADDRESS <br />� <br />DESC. <br />BLOCK <br />PARCEL TN( I.D. # <br />�CO TRACTOR ADORESS CITY2IP PHONE <br />►�,���r�;/�1;� �.r�. /�o r��. 3z�� Fiv.� �� ��.�� <br />CONTii. LI ENSE N . _ , ,� ,,. �_ , . _ <br />USE OF <br />// <br />H� <br />� <br />l�'�,� /qli�j a� j� <br />PLUMBING <br />NO. TYPE OF FI%TURE OR ITEM <br />Toilet <br />� Balhtub <br />Lavalory (wash basin) <br />� Shower <br />hen sink 8 disposal <br />Laundry <br />Sink (servic ' arh <br />Back(low prev e <br />Urinai <br />Drinking Fountain <br />Floor drain <br />Greasc irap <br />Roo( drains <br />Olher <br />HEATSOURCE <br />�clric _ Gas _ Olher <br />���C ��i�ti�_� <br />CONTRACT PRICE OF WORK <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />as range <br />C es dryer <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />I hereby ceritify that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give aulhonty to violate or cancel the provision ol any olher state or local law regulating constructon or the performance of <br />constructi That I am authorized by lhe owner o( this property to periorm lhe work for which appiication is made and I campty wilh the <br />Stale C ntr�„k*!p Law;.f.27ACW and 296.200 WAC. . ! <br />��2 <br />