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ERMIT APPLICATION <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 /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> bvGy,P-7t sk-hel DICT � P,0- 6k% •NoICZ <br /> TENANTNAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR t/Q,fWG1l MrG444 i r( ADDRESS P,O,16cK 1/2.77 TYZI PHONE A 04-90-024S' <br /> \�Nb"I'4C ISL 1(/(. ??//d <br /> CONTR.LICENSE ft 6/AH WFrA ( ( Q�L, //O�0%^1 .��hhylb <br /> USE OF BUILDING+ HEAT SOURCE J CONTRACT PRICE OF WORK <br /> g�S �CI f1 I jr— 2�Electric Gas_Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) L Gas piping <br /> _ Shower Water heater <br /> _ Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> Backflow proventer Heat pump <br /> _ Urinal Unit healer <br /> _ Drinking Fountain Boller <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> _ <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> 1 hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinates governing this type of work will be complied with whether specified heroin or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other stale or local law regulating construction or the performance of <br /> construction. That I am authorized by the owner of this property to perform the work for which application Is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> /✓ir/�kU W-C -0-1 <br /> Sig-nature o er/Contraclor/Authorized Agent Date <br /> I�Z <br />