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<br /> PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIY SERVICES
<br /> 3200 CEDAR STREET, EVEF2ETT, 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.iM PERMIT M
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<br /> LEGAL f LOIT NOr.- BLOCK TRACT � 1 l
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<br /> OWNER ADDRESS .,}„ �� CITY2IP PHONE
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<br /> TENANT NAME I CONTACT FOR PERMIT .� PHONE
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<br /> CONTRACTOR � n �`� , i �, • ADURE .�� CITY2IP PHONE
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<br /> CONTR.L�CENSE M (-� ���.�S-. ". }� � � ... .; /•^ 2.> \ > - :� - '-� �' _
<br /> I�G ( %T J -
<br /> USE OF BUILDING � I HEAT SOURCE CONTRACT PRICE OF WORK
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<br /> ��;�-, .y:,, -j, . _Electric _Gas_Other ��
<br /> WORK DESCRIPTION C '
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<br /> PLUMBING MECHANICAL
<br /> N0. TVPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM
<br /> Toilet A/C-air handling units
<br /> BathWb Forced ah systems
<br /> Lavatory(wash basm) _ Gas piping
<br /> Shower Water heater
<br /> Kitchen sink 8 disposal Gas fireplace
<br /> � Dishwasher Gas range
<br /> Clothes washer Clothes dryer
<br /> Laundry�ray _ Range hood
<br /> Sink(sernce/badmop/etcJ Exhaust lan
<br /> Backllow preventer _ Heat pump
<br /> Urinal Und heater
<br /> Drinking Fountain _ Boiler
<br /> Floor drain Refrigeration
<br /> Grease irap Woodstove
<br /> Roo1 drains O�her
<br /> Other
<br /> CITY Oi EVERETT LOCAL SALES TAX CODE IS J105
<br /> II hereby cenlify lhat I have read and ezammed thrs appGcalion and know the same to be true end corted. All provisions of laws and
<br /> �. ordmaces govemmy thls rype of work will be complied with whether specified herein or noi. The granting of a permd does not presume
<br /> to gNe authorny to violate or cancel the provislon of any olher state or local law regulaling construc6on or the perinrmance of
<br /> constructlon. That I am authonzed by the ownar of this property to perlorm the work for which appGcation is made and I comply wilh the
<br /> State Conlractors Law 1827 RCW and 296200 WAC.
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<br /> Signature o OwnedContrac oi uthonzed gent � te
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