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P�rtMIT APPLICATIG�J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everethva.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />� ,, a <br />N0. <br />TENANTNAME � <br />,N <br />CONTRA� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK D�CRIR� <br />;�X �� <br />� �� <br />BLOCK <br />PARCEL TAX I.D. # <br />s96� D0. <br />ivV�' <br />AODRE53 <br />FOR PERMIT <br />HEATSOURCE <br />Eiectric Gas Other <br />PERMIT M <br />/� / D p (�SD/ �l I <br />1 1 D `v T <br />CITY2IP PHONE <br />u.,�a �✓ er-e� 3 3 9� �� <br />PHONE <br />�1 � 3 9-�1� l� <br />CITY2IP PHONE <br />I CONTRACT PRICE OF WORK <br />—r�.�� .��.r, L�P�br�-., �- �- � <br />��,,�,��..�� �� �, � ��- y� <br />NO. I TYPE OF FIXTURE OR ITEM <br />� ✓ oilet <br />I thtub <br />I � Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (s3rvice/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floar drein <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />Forced air systems <br />Ges piplflg <br />Water heater <br />Gas flrepiace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaustfen <br />Heat pump <br />Unit heater <br />Boiler <br />RefigeraUon <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this applicalion and know the same to be true and correct. Ail provisions of laws and <br />ordinaces governing this rype of work will be complied wth whether specified herein or not The granting of a permit does not presume <br />to give aulhority to violate or cancel the provision of any other state or local law regulating consWction 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 1 comply with the <br />