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SITE ADDRESS <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />�� <br />TENANTNAME <br />. !;. <br />CONTRACTOR <br />PERMIT APPLiCATI�N <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 ACCEPTED FROM 0 AM TO 4 PM <br />PARCEL TAX I.D. # <br />�J �iY��n' nnf n'/�)� • �� <br />6LOCK � TRACT <br />CONTR.UCENSE#�GC'IAC��IO��� `� <br />USE OF BUILDING <br />F� <br />YJORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITFM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />EackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />� <br />���� S�•S�e�en5�• <br />CONTACT FOR PERMIT <br />b —b —�% <br /># <br />ITILIY rn�ne <br />.S�-evevtS ��ZS.,�a��`�•0.5�3 <br />5758' <br />AODRESS CITYIZIP <br />. <br />. . ... .�: <br />HEATSOURCE <br />Electric � Gas Other <br />� <br />PHONE <br />. . r.` � � . <br />n <br />. ., <br />PHONE <br />,'. . . <br />CONTRACT PRICE OF WORK <br />MEGMANIGAL <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Wacer heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heatpump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CIN OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby ceritify that I have read and examined this application and know the sam� to be true and correcL All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specifed herein or noL The graniing of a permit does not presume <br />to give authority to violate or cancel the provision of any other slate or local law regulating construction or the performance of <br />con:;truction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Cont`actors Law�1827 RCW nd 296.200 WAC. f / <br />� I ( <br />��<=''�� �����/l� % �1�i�0� <br />fSignaWre of Owne 1Ccn ractor7Authorized Agent Date � <br />/✓ <br />