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SITE ADDRESS <br />LEGA LO O. <br />DESC. <br />TENANTNAME <br />P�RMIT APPLICA <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 <br />BLOCK <br />� <br />PARCEL TAX I.D. �F <br />TRACT <br />CONTAGT FOR PERMIT <br />CONTRACTOR n / • �/"' ADDRESS <br />CONTR. UCENSE it / ��'1 � d � ' ' �� <br />USE OF BUILO�NG <br />DG� N� /-i C.��� <br />WORK DESCRIPTION <br />5�,�, .tiL(.�-�, <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Waler healer <br />Sink (service/badmop/elc.) <br />6ackflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease irap <br />Roof drains <br />Olher _ <br />HEATSOURCE <br />_ Eleclric _ Gas _ Olhcr <br />/ 9� �°��'s <br />6—� ��O <br />PERMIT � <br />� (y b!o - <br />PHONE <br />CITY2IP PHONE <br />I CONTRACT PRICE OF WORK <br />NO. I NPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas tireplace <br />Gasrange <br />Clolhes dryer <br />Range hood <br />Ezhaustfan <br />Heal pump <br />Unit heater <br />6oiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby cerilify Ihal I have read and examined this application and know the same to be irue and correcL All provisions of laws and <br />ordinaces goveming this lype of work will be complied with whelher specified herein or not. Tho grenling of a permit does nol presume <br />to give aulhonty to violate or cancel the provision ol any other state or local law regulating conslruction or the peAortnance of <br />construclion. That 1 am aulhorized by the owner of Ihis property to parform the work for which application is made and I comply with lhe <br />State Contractors Law 18.27 RCW and 29G.200 WAC. <br />Signalure ol OwnedContraclor/Authorized Agenl Date <br />