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PERMIT APPLICATI N <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 3 – L —toted <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT# <br /> 'TO J Z,.�rte ,v r` w"` oSc_-) -oo a <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE 4''Z5 -Z <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR. LICENSE# <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> X Electric Gas .\ Other <br /> WORK DESCRIPTION <br /> fJ,pp ?RD PAN faA <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) Gas piping <br /> Shower Water heater <br /> Kitchen sink& disposal Gas fireplace <br /> Dishwasher Gas 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 / Other p2.-)pfJNKF <br /> Other <br /> CITY OF EVERETT LOCAL 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 correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state 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 /> a e on tors Law 18. W and 296.200 WAC. <br /> • mil p <br /> Si.nature of Owner/ .ntractor., orized Agent D t � <br />