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PERMIT APPLICATION <br />CITY OF EVEPETT 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 PPlI <br />SITE ADDRESS � <br />,p� PL�I a�)tZ S'. <br />L[GAL LO NO. BLOCK <br />�ESC. <br />OWNER � <br />�-�INN I��,11.��. <br />TEI ANT NAME <br />CONTRACTOR�.� �� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />/ PARCEL TAX I.D. # <br />� ,'�� � .�� -. <br />TRACT OR SUBOIVISION # <br />ADORESS CITYIZIP <br />��1�r�v IZ��Z- <br />CONTACT FOR PERMIT i � <br />ya <br />ADDRESS CITYIZIP <br />HEATSOURCE <br />Eleclric Gas Other <br />WORK DESCRIPTION <br />��� w � � <br />� <br />NO. I TYPE OF FIXTUftE OR ITEM <br />Toilet <br />�alhWb <br />Lavatory (wash basin) <br />Showe� <br />Kitchen sink 8 disposal <br />Cishwasher <br />Clothes �vasher <br />Water heater <br />Sink (service/bar/mopfetc.) <br />� �ack0ow prevenler <br />Urinal <br />Drinking Pounlain <br />Floor drain <br />Grease �rap <br />Roof drains <br />Other <br />� -- 9 �O <br />�- - DU'�- <br />CONTRACT PRICE OF WORK <br />N0. I TYPE OF FIXTURE OR ITEM <br />� <br />!VC — air handling units <br />f-'orced air systems <br />Gas piping <br />VJaler heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust /an <br />Heat pump <br />Unit heater <br />lioiler <br />Refrigeralion <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know Ihe same lo be irue and correct All provisions of laws and <br />ordinances governing this type of �t�ork will be complied with vihether speci�ed herein or not. The granting ot a permit does nol presume <br />�o give authority lo violale or cance� Ihe provision of any other slate or loca� Ia�v regulating construclion or the per(ormance of <br />cons�ruction. That I am authorized by �he u�vner o( ihis property to perform lhe work for which appficalion is made and I comply with Ihe <br />�,..�,. �,...�..,,.e,..� �.,,,� � a�� nrin� �.,.� �or, �nn �ninr. <br />