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C <br />PEKMIT �4PPLICA�'ION <br />CITY OF �VERETT PERI�IfT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - F/�X 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /><CJJ <br />C.: �n �% �`) <br />LOT N0. BLOCK <br />; ( lu� <br />TENANTNAME <br />C�I F, <br />CONTRACTOR <br />�C/ �J <br />CONTR. LICENSE # <br />USE OF 3UiL01NG <br />S1-t <br />WORK <br />C;���1�1'►��� }� <br />�.��� ��� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />DathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 �iisposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/bar/mo;>/e�c.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />P,00( drains <br />Other <br />PARCEL TAX I.D. # <br />C��r`s�3 �, c��-i <br />/�TRACT <br />V <br />�ul�{ �� f�� W <br />CONTACT FOR PERMIT <br />���, �:�,.�e.S <br />AODRESS <br />HEAT OURCE <br />�-:�4"`C � <br />_ [leclric __ Gas _ Other <br />�,�L �� � <br />YO. I <br />� <br />,E�MIT#/' /„ <br />. �; � `� <br />f �V(( �(ti Z�-'� <br />PHONE <br />�-{ z� 3 3� �t�t ��"1. <br />CITY/ZIP PHONE <br />I CONTRACT PRICE OF WORK <br />� <br />� <br />(;AL <br />TYP[ OF FIXTURE OR ITEM <br />NC – air handling uni'.s <br />5orced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clcthes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVGRETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y lhal I have read and examined ihis applicalion and know lhe same lo be true and correct. All provisions of laws and <br />ordinaces governing this type of work �vill be ccmplied with whelher speci(ied hereir. or not The grantin� of a permit does nol presume <br />to give authority lo violate or cancel Ihe provision of any othzr slate or lo^al law regulating consiruction or the performance of <br />consiruction. That I am authorized by the owner of this property lo per(orm the work for which applir,ation is made and I comply with lhe <br />Slat�-Conlracfors Law 1827 RCW and 29G.20^ \NAC. <br />— � ,.. �:. � � ( .�-� C� � ,2 . � r `� . <br />/ <br />