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PERMIT 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 /> LEGAL LOT NO. BLOCK TRACT OR SU DIVISION# <br /> DESC. <br /> � F <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE 412_-r <br /> /'(/17- —, <br /> �CE-MAIL L2S141A 7 l-0[1e�� <br /> COJJTRACTOR �� 41r���fa�� r LC ADDRESS CITY/ZIP PHONE n r N <br /> L� L <br /> �Z-� 34c--73,4 ��✓ ' YFvftt e,-(l yes 3 �S� I68A <br /> CONTR. LICENSE# q o w3 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric _Gas_Other 27 0 0,D D <br /> WOftk DESCRIPTION q <br /> rzt-a-r 0C0--,LX i S~ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet — A/C -air handling units <br /> 2 Bathtub Forced air systems <br /> `� Lavatory (wash basin) Gas piping <br /> Shower Water heater A� , <br /> Kitchen sink&disposal / Gas fireplace <br /> Dishwasher M'— Gas range <br /> Clothes washer _Y Clothes dryer <br /> 2� Water heater x 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 <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinances 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 /> State Contract s Law 18.27 RCW and 296.200 WAC. <br /> Signature of 0wner ac or Authorized Agent Date _/� <br />