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F��RMIT APPLiCA�IVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRELS1 PARCSI TAX I.D.N I PERMIT f -n/� <br /> /�f(J� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS C1TY21P PHONE <br /> lJ S ��V�fa 1Y�i c�l�� Y C]2'��U�'eS , � <br /> 7ENANT NAME I CONTAC F R PERMR PMONE <br /> 1 U� � S <br /> CONTRACTOR ��,e,�- ADDRE33 CITY2IP � E <br /> CONTR.UCENSE li <br /> USE OP BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �UJ�i v� .e u,cp,�r�,� �y Electric _Gas_Other <br /> WORK DESCR TION �— ,� <br /> �V�� e �StOC �MCkb �0.w ,eSs <br /> �ea �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. 7YPE OF FU(7URE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> _ Shower � Walerheater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher as range <br /> Clothes washer Clothes dryer <br /> � Water heater _ Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOC/LL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and comect. All provisions of laws and <br /> ordinaces goveming this lype of work will be complied with whelher specified herein or not.The granting of a pertnit does not prasume <br /> to give authorily t or cancel lhe provision of any other state or local law reguladng consWction or the perfortnance of <br /> wnslruclio at authorize y lhe owner of this property to perfortn he work for which applicadon Is made and I comply with the <br /> State trac Law nd 2 . 00 WAC. <br /> � � . <br /> / -4 0�c <br /> Sign re of OwnedContraclor/Aulhorized Agent ate <br />