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PE��MIT APPLIC�4TI0�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />��o L <br />LEGAL LOT N0. <br />� L' � <br />TENANTNAME <br />v,�-L� - <br />BLOCK <br />CONTRACTOR <br />CONTR. LICENSE # ` L � � <br />USE OF BUILDING <br />C�-(� <br />WORK DESCRIPTION <br />%� <br />NO. I TYPE OF FIXTURE OR ITEM <br />i ,- <br />PARCEL TAX I.D. # <br />TRACT <br />CONTACTFOR PERMIT <br />��I�iUIC l_( �`G�-: <br />A�DRESS CIN21P <br />— HEATSOURCE f. <br />i <br />Eleclric Gas Olher <br />Toilet <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbarimop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />OtherC`n'�'C�'rEK/.577,(.F s�1i;c,:."�r.,.�iNic <br />12C�2 <br />PHONE <br />i!C �/;_ <br />PHONE <br />OF WORK <br />_ �./.rnn ��U <br />TYPE OF FIXTURE OR ITEM <br />NC — air handling units <br />Forced air systems <br />Ga� piping <br />W ater heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodsiove <br />CIN OF E`:ERETT LOCAL SALES TAX CODE IS 3�05 <br />I hereby ceritify lhat I have read and examined this application and know the same to be true and correct. All provisions oF laws and <br />ordinaces governing this type of werk will be complied with whether specified herein or not. The granting o.` a pemit does not presume <br />to give authoriry to vioiate or cancel the provision of any other state or local la�.v regulating construction or the performance of <br />construrtion. That I am authorized by the owner of this propeRy to perform the work fer which application is made 2nd I comply �vith lhe <br />State ',•traGlors La�v 18.27 nd 29".� 0 bVAC. <br />.r- - � �� ////,�:%�� �/ /� <br />i . /C , _ %� / /G 1 <br />�/Z <br />