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p.�f�l'�lllT e4PF'�ICAT1�.�► <br />CITY OF Ei/EI�ETT PERMIT SERVICES <br />3200 CEDAft STREET, EVERETT, WA 98201 <br />425-257-8810 — F.4X 425-257-8857 — www.evereltwa.org <br />APP�_ICHTIONS ARE ACCEPTED FROM E AM TO 4 PM - DE81T & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />��� � <br />LEGAL LO' NO. <br />DESC. <br />OWNER <br />�-� <br />��NANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />� v.� ��`--� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Tailet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/bar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roo( drains <br />Olher <br />PARCEL TAX I.D. # <br />TRACT <br />��� �� <br />CONTACT FOR PERMIT <br />AD�RESS <br />HEAT SOURCE <br />_ Electric _ Gas _ Other <br />PERMIT # <br />PHONE <br />C17Y21P PHONE <br />I CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />Forced air syslerns <br />Gas piping <br />Water he�der <br />Gas firepiace <br />Gas range <br />Cblhes dryer <br />Range hood <br />Exhaustfan <br />Heat pum� <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />� hereby cerilify thal I have read and examined this appl`�alion and know the same to be true and correct. All provisions of laK�s and <br />ordinaces gcverning lhis type of work v�ill be complied with whelh�r specified herein or nol. The grantin� of a permit does nol presume <br />to give authority to violate or cancel the provision of any other stale or local law regulating construc6an or ihe per(ormance of <br />construction. That I am thorized by the owner nf this property to perform the work for which applica:ion is made and I comply with lhe <br />State Contracto T a�v/1�RCW and 296.200 WAC. <br />/ll ���.J� <br />