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P�:RMIT APPLICATI�.N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA y8201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDR CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />LEGA LOT N0. <br />DESC. <br />TENANTNAME <br />CONTRACTOR /� <br />i <br />CONTR. UCENSE N � k <br />USE OF BUILDING <br />BLOCK <br />W�DESCRIPTION � <br />h��d � �� ��� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mopletr,.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />PARCEL TAX I.D. f1 <br />TRACT <br />� �l% 0 `� �E <br />CONTACT FOR PERMIT <br />ADDRESS <br />PERMIT A� %' <br />�'� D� � � �� <br />CITY2IP PHONE <br />— HEAT SOURCE I CONTRACT PRICE OF WORK <br />Electric _ Gas _ Other <br />� �— � / <br />�y�..,.. .1�:�,0�� /o �Y J' Ti !- e �J � c � <br />� � <br />NO. I TYPE UF FUCTURE OR ITEM <br />A/C – air handling units <br />Forced elr systems <br />Gas piping <br />Water heater <br />Gas flreplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby ceritify that I have read and examined this applicaGon and know the same to be true and cortect. All provisians of laws and <br />ordinaces goveming this rype of work �vill be complied with whether specified harein or not. The granUng of a pertnit does not presume <br />to give authority to violate or cancel the provision of any other st2te or local law regulating construction or the perfortnance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Stat n clors Law 18.27 RCW a 2 2 C. <br />%ei� `� i�-�� �, �f cy <br />