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<br />, PERMIT APPLICATION
<br />CITY OF EVERETT PERMIT SERVICES
<br />3200 C[DAR STRE[T, EVERFTT. WA 98201
<br />425-257-£3(110 - PAX 425-25i -t3857 - vnvw everethva orq
<br />APPLICATIONS ARE ACCEP7ED FROM 8 AM T04 PM
<br />SITE ADDRESS PARCEL TA% I.D. 1t � ,P�RMIT M �o� i'
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<br />i I I �;.� lOT NO �-�.. � BLOCK � TRACT
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<br />OWN[R , . , ADDRESS CITYIZIP PHONE � 1.��> >,� .,
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<br />� TENANT NAMf CONiACT FOR PERMIT PHONE
<br />CONTRAf.TOR'-'�"�- �
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<br />� CONTH. LICENSE M
<br />USE OF BUILOING
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<br />, WORK DESCRIPiION
<br />NO.
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<br />� ADDRES� � CITY/TIP pHONE
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<br />PLUMBING
<br />TYPE Of fIxTURF OR ITFM
<br />f oil���
<br />P�ithluh
<br />_ Lavaloiy (wash basinl
<br />Show�r
<br />Kd�'hcn sink R d�sposal
<br />Dishwashei
<br />Clolhes washr.r
<br />-- Laundry hAy
<br />Suik (serv¢.r�badmop�e�c 1
<br />f3aCMllow preven�er
<br />Unnal
<br />Druiking Fountan
<br />florn drain
<br />� Greasetmp
<br />Rouf diamc
<br />Other
<br />_.-- - �---- ------ - -------
<br />HEAT SOURCE CONTRACT PRICE OF WORK
<br />Eleclnc �` ,:r, O�her .
<br />.� . ,, , ,_ � ,,+, , �
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<br />MECHANICAL
<br />NO. I TVPE OF FlXTURE OR ITEM
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<br />A �' a,i I�an�lhny unq.
<br />_ �� i �:nced an sys��nts
<br />GTs pipm9
<br />Watei heater
<br />Gas lueplare
<br />__ Gas range
<br />Clolhes dryei
<br />Range hood
<br />ExhauSt 10n
<br />_� Haa� pump
<br />___ Unit hea�cr
<br />Botler
<br />Refngeialion
<br />Woodslove
<br />Other
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<br />CRY OF EVfHF.TT IACAL SALES TAx LODE IS J105
<br />i nr�reby cenhty thal I huve �ead and .,..in��n��.l ti���, .i����,��irai�.c.�� ,in�l wn„�;. D,.. ,..n,.,. i�. b.�. tnn� and correct All prowsiuns ol laws and
<br />�. �� I�neces goven❑ng Ilns type ol wnrr wdi 1,N , om� d„�J vnth r:hr�li�a� ci�.,-,-�i�.- � i�ri•���� „� net t ne g�anling of a permd d�as not presume
<br />�. �;��ve aulhonty to wnlate or wnrr�i Ihe piowsmn nf any othr.� stete oi lo�:al la�v iegulaliny ronslructiun or the peiformance ol
<br />�iwliuctici� ih2� I am eitlhOnZed by Ihr ownei of Ih6 p�opPrtV to peifomi the worY for which apphr,ation is made anA I comply wdh �he
<br />.tnte Conhadors l.aw 1P 2� RCW and 29fi 200 WAC .
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