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P�RMIT APPLICATIOM <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 />AP►�UCATICNS ARE ACCEPTED FROM 8 AM 7'O 4 PM <br />$17E ADDRESS <br />� � 5�� � <br />LEGAL LOT NO. BLOCK <br />DESC. <br />_ rNba- �I�. /-�I���J <br />TENANT/ NAME <br />li— � � <br />�,J <br />i <br />CONTR. LICENSE # ' ) N: <br />(N <br />USE OPHUILDING <br />WORK DESCRIPTION <br />/ PARCEI TAX I.D. # <br />w <br />NO. I TYPE OF F�XTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposai <br />Dishwashor <br />Clothe� washer <br />Water healer <br />Sink (service/bar/mop/elc.) <br />BackFlow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />TRACT OR SUBDIVISION # <br />�I�7 S r�-`'s�#-.S.c.t�. <br />I CONTACT FOR PERMIT PHONE <br />e-Ma� <br />�� <br />HEAT SOURCE <br />Electric Gas Olher <br />CONTRACT PRICE OF WORK <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handfing units <br />Fo�ced air systems <br />Gas piping <br />bVat2r heater <br />Gas Tireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL �ALES TAX CODE IS 3705 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing lhis lype of work will be complied with whelher specified herein or not. The granting of a permit does not presume <br />to give authority lo violale or cancel the provision of any olher stale or local law r�gulating consWclion or the performance of <br />construction. That I am authorized by the owner of this properly to peAorm the work for which application is made and I comply with the <br />State C��ractqrs Law 18.27 I�W. �d 296.200 WAC. <br />�•�p•U <br />