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��RMIT APPLICATI(,.N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9B"�1 <br />425-25T•8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM S AM TO 1 PM <br />SITE ADDRESS <br />�s1�s 9 �I �' <br />LOT NO. <br />PARCEL TAX I.D. A <br />zs.ZJ)-1�37 <br />CONTRACTOR ADDRES6 CITY2IP PHONE <br />CONiR. UCENSE / U � , p � , <br />/..���� <br />USE OF BUILDINO <br />WORK DE8CRIPTION <br />MEAT SOURCE I CONTRACT PRICE OF WORK <br />�Electric _ Gaa �Other <br />�� x �� ���- <br />NO. I TYFE OF F�XTURE OR ITEM <br />Tollel <br />Balhlub <br />Lavelory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clathes washer <br />Laundry tray <br />Sink (aervice/bar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlaln <br />�loor drain <br />Groese lrap <br />Rool dralns <br />Olhar <br />NO. <br />TYPE OF FU(TURE OR ITEM <br />A/C — eir handllnp unita <br />Forced elr syeteme <br />Oae plping <br />Weter heater <br />Gae flreplace <br />Gas renge <br />Clothea dryer <br />Rengehood <br />Ezhsuat fan <br />Heat pump <br />Unit heeter , `- , <br />Boller �, i��[ <br />ReMgeraOon �� � <br />woor,stove <br />Olher C <br />✓ <br />CITV OF EVERETT LOCK 6ALE! TAl( CODE IS 1106 <br />I hereby cedlify thet I have read and ezamined lhle appllcalion end krrow the same to be lrue and correct. All provlelons al lawe and <br />ordinaces governing this type ut work will be complied wlth whelher apecmed hereln or noL The grenting of e permN does nol proeume <br />lo give eulhority lo violate o; cancel Ihe prov�sion ot eny other stale or local lew repulating conalructlon or the perloimanrn o1 <br />conslruction. Thet i am auY,iarized by the owner ol thls property to peAortn the work for which eppllcatlo� ie made and I comply with the <br />Stato Gqnlrectore Lg�� 7c.27 RCW and 298.200 WAC. <br />��Z <br />