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PE�eMIT APPLICATIO�� <br />CITY OF EV�RETT PERMIT SERVI�ES <br />3200 CEDAR STREET, EVERETT WA 9820 i <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDR �. <br />���/3 _ � , � <br />LEGAL LOT N0. BLOCK <br />TENANTNAME <br />CONTRACTOR <br />l <br />CONTR. LICENSE � �� <br />� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. � 7YPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/6admop/etcJ <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Fioor drain <br />Grease trap <br />Roof drains <br />Other <br />PARCEL TAX I.D. � <br />TRACT <br />CONTACT FOR PERMIT <br />ADDRE55 <br />HEATSOURCE <br />Electric Gas Other <br />PERMIT � <br />rnoyos-r� <br />PHONE <br />CITY/ZIP PHONE <br />//��/G'� <br />I CONTRACT PRICE OF WORK <br />N0. I TYPE OF FIXTURE OR ITEM <br />A!C — air handling uniis <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Gothes dry, er <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Reirigeration <br />1Noodstove <br />Other . <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3�05 <br />I hereby ceritihj that I have read and examined this zpplicatlon and kno�v the same to be true and correc!. All provisions of laws and <br />oMinaces governing this type of work will 6e complied with whether specified herein or not. The granting uf a permit does not presume <br />to give authonry to violate or cancel tha provision of any othe� state or local law regulating consWction or the perfermance of <br />construcuon. That I am authorized by the owner of this oroperty to perform the work tor �vhich application is made and I comply �.vith the <br />Siate�ontr §tors aw 2� R'� and 296.200 WAC. U r� <br />�' G -�� �;� — � �`�lJ�`S' <br />Signature ot OwnerlContract�P :horized Aae�n Date <br />