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SITE ADDRESS <br />LEGA LOT NO. <br />�ESC. <br />OWNER <br />TENANT NAME ; � <br />PE.IMIT APPLICATIO.. <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. �i <br />BLOCK I TRACT OR SUBDIVISION # <br />CONTACT FOR PERMIT <br />PHONE <br />I E-MAIL <br />TRA T ADDRESS C TY/Z <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DcSCRIPTION <br />����� <br />y-ao-�a <br />PERMIT # <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric Gas Othzr <br />(/L VP-�7`" <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilrt <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Fiack(low preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease irap <br />Roof drains <br />Other <br />�� ������ <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unit� <br />Forced air systems <br />Gas pipine <br />Water heatrr <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />4Voodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� hereby certify that I have read and examined this application and know the same to be true and correcL All provisions of laws and <br />ordinances governirg this lype of work will be complied tvith whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel lhe provision of any other state or local law regulaling construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I compiy with the <br />Sta!e Cbntractors Law 18.27RCW apd 296.200 WAC. , <br />