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j�>��, <br />SITE ADDRESS �� <br />�_ �� <br />L[GAL LOT NO. <br />oesc. � <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERViCES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACC'cPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.O. # <br />;� ,;.�=,� <br />i ,� ` <br />BLOCK TRACT <br />r ' �aatt�e� � � <br />ADDRESS � CITYIZIP PHONE <br /># <br />v� • I �. _ _` • • ,�� ' J <br />CONTRACTOR � A�DRESS CITYIZIP PHONE <br />r�, . . . <br />CONTR. LICENSE # . •� � " ' <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. I TYP[ OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash 6asin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.� <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEA7SOURCE <br />_ Electric � Gas <br />CU7 <br />Oltier <br />CONTRACT PRICE OF WORK <br />L <br />TYPE QF FI%TURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas freplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust(an <br />Heat pump <br />Unit heater <br />8oiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3705 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or noL The granting of a permii does not presume <br />to give authority to violate or ca� �cel the provision of any other state or lo.al law regulating conshuction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work (or which application is made and I comply with the <br />State Contracrors L w�18.27 RCW and 296.200 WAC. <br />J <br />�� h.litr � �,t �� iS� �— <br />t�gr�ture of wner ntrac odAuthonzed Agen Date . <br />r� <br />L <br />