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PERMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVIC�S <br /> 3200 CEDAR STREET, EVERFTT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �g`a,`D� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT iF <br /> n�a�08—o3�t <br /> IEGAL LOT N0. BLOCK TRACT OR SUBOIV��ION# <br /> DESC. <br /> OWNER AODRESS CITY2IP PHONE <br /> / `�0 � Q �vn�u ���� 9��0/ <br /> TENANT NAME CONTACT FOR PERMIT � PHONE ' <br /> `� � C <br /> ������� �� J � G l E•MAIL <br /> ONTRACTOR / �_�`/�����RESS YIZI�ONE <br /> � <br /> r,ONTR.LICENSE 7! //i(en1�7���4d KG' 3�`���-� ��'�?�s� 1� ,���.����.�d . <br /> � L <br /> USE OF 6UIL�IiJG HEAT SOURCE I CONT�CT PRICE OF WORK <br /> n cy� <br /> /'/' �i��fl� _Eleclric �Gas_Olher �(� <br /> E /� / <br /> WORK DESCRIPTION ���l/��� ����' ��j��f—��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI�TURE OR ITEh7 <br /> Toilel A/C—air handling unils <br /> Bathlub / Forced air syslems <br /> Lavatory(wash basin) � Gas piping <br /> Shower Waler heater <br /> Kilchen sinM.&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink (service/bar/mop/elc.) _ Exhausl fan <br /> BackOow prevenler _ Heal pump i <br /> Urinal Unit healer <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodslove <br /> Roof drains Other <br /> Other <br /> CITY GF EVERETT LOCAL SALES TAX CO�F IS 3105 <br /> I hereby ceriti(y lhal I have read and examined Ihis application and know the same lo be lrue and correcL Ail provisions of Iaws and , <br /> ordinaces goveming lhis type o(work will be complied with whelher specilied herein or noL The grantiny of a permit does nol presume <br /> to give aulhorily to violate or cancel lhe provision of any olher state or local law regulaling consWclion or the performance of <br /> conslruction.Thal I am�uthorized by lhe owner o(this property lo perform fhe work tor which application is made and I comply wi!h the <br /> State Contra��La_c��RCW and 296.200 WAC. j <br /> � <br /> SignaWre of O nedConlractodAulhonzed Ac�ent Dale <br />