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SITE ADDFESS <br />L-� <br />LEGAL LOTNO. <br />DESC. <br />OWNER <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />PCRMIT APPLICATIC�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 8 AM TO 4 PM <br />� � �' <br />BLOCK <br />PARCEL TAX I.D. # <br />TRAC7 <br />CONTACT FOR PERMIT <br />ADDRESS <br />HEATSOURCE <br />_ Eleclric _ Gas <br />.� <br />I�c;�qm�r5 �'� , sc� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilcl <br />[3alhlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />W ater heater <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease irap <br />Roof drains <br />Olher <br />�. � Z�D� <br />r# <br />PHONE <br />CITY/ZIP PHONE <br />CONTRACT PRICE OF WORi( <br />Olher <br />�J' <br />� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air syslams <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range huod <br />Exhaust fan <br />Heal pump <br />Unit heater <br />Boiler <br />Re(rigeretion <br />Woodslove <br />Other <br />CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y lhat I have read and examined this application and know the same to be true and correcL All provisions of laws and <br />ordinaces governing ihis lype of worh will be complied with whether specified herein or noL The granting of a permil does not presume <br />to give aulhority lo violate or cancel the provision of any other state or local la�v regulating construclion or lhe performance of <br />construction. That I am authbrized by the owner of this property tt� perform lhe work for which ap�lication is made and I comply with Ihe <br />Slate Contractors Law 18.27j�iCW and 296.200 WAC. � j <br />SignaWre of OwnedConi <br />J <br />