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SITE ADDRESS <br />� �/� �/` <br />LEGAL LOT NO. <br />DESC. j _,�. ' <br />TENANTNAME <br />', �RMIT APPLICATt �N <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 />�f `:�•J <br />BLOCK <br />PARCEL TAX I.D. # <br />OR SUBDIVISION # <br />ICONTACT FOR PERMIT <br />�7 N <br />PHONE <br />AO�IitJJ �• •••.•• `�� <br />��, �,,,, �.� F;,.,, ,z,-�w rn,Y/ Cl���k � <br />, <br />..a--i � <br />'�_"'`-'4! <br />� <br />CON�R. LICENSE N y <br />J ��'}`'l�'� /f �%/ 7%S � <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />C��� <br />WORK DESCRIPTION <br />/ V�-� 1 ��'��_ <br />NO. I TYPE OF FIXTURE OR ITEM <br />�3 Toilet <br />� Bathtub <br />� Lavafory (wash basin) <br />Shower <br />l Kitchen sink & disposal <br />I Dishwasher <br />� Clothes washer <br />�_ Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Greasc lrap <br />Roof drains <br />Olher <br />_ Electric TGas _ Other <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />� Forced air systems <br />� Gas piping <br />� Waterheater <br />� Gas fireplace <br />i Gas range <br />Clothes dryer <br />� Range hood <br />�_ Exhaust(an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify lhat I have read and examined this application and know the same lo be lrue and correcL All provisions of laws and <br />ordinaces goveming lhis type of work will be complied with whelher specified herein or not. The granting of a permit does not presume <br />lo give authority lo violale or cancel the provision of any other state or local law regulaling conslruclion or lhe performance of <br />construclion. Thal I am authorized by lhe owner of this property lo perform the work for which applicalion is made and I comply wilh lhe <br />Slale Contrectors Law 1827 RCW and 296.200 WAC. <br />Signature of OwnedContraclor/Aulhorized Agent Date <br />