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P. .RMIT APPLICATIt�N <br />CITY OF EVERETT PERMiT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />���, �N� <br />LOT NO. BLOCK <br />TENANT NAME <br />PARCEL TAX I.D. # <br />ICONTACT FOR PERMIT <br />� <br />°��iel2�-H- �vilde�s 1r�:�°�i�.g►8 �3�A� <br />BUILDING <br />WORK DESCRIPTIO � o <br />��+� � � <br />57a'� C <br />0 <br />NO. � TYPE OF FIXTURE OR ITFM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Cblhes �vasher <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />BackOow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />HEAT O•U^R_C,F�p <br />_ Eleclnc � G� aS — Other <br />c/aSSI �l 3��1 <br />.�-�-7i�1 <br />PRICE OF WORK <br />� � <br />NO. I 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 />Gas range <br />Clothes dryer <br />Range hood <br />,� Exhaustfan <br />Heat pwnp <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />Other <br />� � <br />CITY OF EVERETT LOCAL SALFS SAX CODE IS 3105 <br />I hereby ceritity that I have read and ezamined this applicatinn and know the same ro be true and cortect. All provisions of laws and <br />ordinaces governing lhis type of work will be complied vnth whether specified herein or not. The granting of a permit does not presume <br />ro give authod to v�olate or cancel the provision o( 2ny other state or Iocal law regulating construction or the performance of <br />conslruclion. �t I am authonzed by the owner of this property to perform the work (or which application is made and I comply wilh the <br />State Contrdcto . Law 18.27 RCW and 296.200 WAC. <br />!/ <br />Z <br />