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PE�ZMIT APPLICATIOnI <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 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />'� SITE ADDRE55 <br />I , , : 1< <br />/ r. : � <br />ILEGAL ' LOT NO. � <br />I DESC. <br />i <br />OWNER <br />� i <br />i <br />I�cl ,4�,� <br />TENANTNAME <br />CONTRACTOR <br />PARCEL TAl( I.D. # <br />;� <br />BLOCK TRACT <br />ADDPE55 CIN21P <br />ICONTACiFOR PERMIT <br />AODRE55 CITY2IP <br />CONTR. LICENSE ll . <br />� �(.':�•._ _ <br />USE OF BUILDING <br />�-_,� <br />WORK DESCRIPTION <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />,� � I - fi . . , . � . � . ,. , r' i �, . .... <br />YLUMtSlNCi <br />NO. I TYPE OF FIXTURE OR ITEM <br />TOiIBt <br />� _ Balhtub <br />_ Lavato,y (wash basin) <br />i _ Shower <br />Kitchen sink 8 disposal <br />' Dishwasher <br />I Clothes washer <br />Laundry tray <br />' Sink (service/badmop/etc.) <br />' BackOow prevrnter <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Rool drains <br />Other <br />� P RMIT—�� <br />O � � <br />PHONE <br />� <br />_ �r���'�n j/�� <br />PHONE <br />PHONE <br />CON7RACT PRICE OF WORK <br />NO. I 7YPE OF FI%TURE OR ITEM <br />l <br />A/C — air hand�ing units <br />Forced air .rystems <br />Gas piping <br />Watei heater <br />Gas fireplace <br />Gas range <br />Ctothes d�yer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />8odei <br />Refrigeretion <br />N.'oodstove <br />Other <br />CIN OF EVERETT LOCAL SALES TAl( CODE �S 7105 <br />I hereby cerilify that I have read and examined this application and know the same to be tru5 and correct. All provisions u� laws and <br />.;-rlinaces governinq this rype of work will be complied wlth whether specified herein or not. The granting of a permit does not presume <br />;� give authonty to violate or cancel the provision of any olher state or Iecal '-•.v regulating construction or the peRormance of <br />construction. That I am authorized by the owner of this property to perform : work for which application is made zntl I comply with the <br />Sate Contrectors law 78.27 RC'�N and 296200 WAC. <br />.� . ' _ l/ i.' (/ � (,�'� <br />i. i� <br />'!�% - �%' 'j G o`-i i� <br />