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SITE ADDRESS <br />, <br />LEGAL LOT NO. <br />DESC.j <br />��WNER <br />TEN T �� <br />NTRACTOR <br />CONTR. LICENSE # <br />%)�P% <br />USE OF BUILDING <br />�'\C� f (� Z���N'i , <br />�-L ;�ra.k�,c ' <br />WORK DESCRIPTION <br />�l` v� � <br />PERMIT APPLICATIOI� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.ev�rettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />TAX I.D. R <br />� <br />BLOCK I TRACT OR SUBDIVISION N <br />h <br />CONTACTFOR <br />HEAT SOURCE <br />� Electric _ Gas _ Other <br />��� �`�,�a�P�G <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Ba�htub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink E disuosal <br />Dishwasher <br />Clothes �vasher <br />Waler heater <br />Sink (service/badmop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Ploor drain <br />Grease trap <br />Roo( drains <br />Other <br />PHONE <br />(o �.1�`�� <br />P MIT# <br />7��� - <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gasrange <br />Clolhes dryer <br />Range hood <br />Exhausl fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify lhat I have read and examined lhis application and know lho same l� be true and correct. All provisions of laws and <br />ordinaces goveming lhis type of work will be complied wifh whelher specified herein or nol. The granting of a permit does not presume <br />lo give authoriry to violate or cancel lhe provision of any other slale or local law regulating construclion or the performance of <br />conslruction. That I am aulhorized by the owner of lhis property to perform lhe work for which applicalion is made and I comply wilh the <br />CState Contract�rs Law 18.27 RCW and 296.200 WAC. <br />II 0 <br />