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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 /2 � �� - /7� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM J� �Q /�� Oc�� <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> l � .; P�T RD `T la� oi� -oa � <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OMMER ADDRESS CITY2IP PHONE <br /> �11:1%Zn �� l�;s.rns,r,� Pr��! LGC <br /> TENANT NAME Q CONTACT FOR PERMIT PHONE � <br /> � � ��n�� "-�� I E-MAII <br /> C $ <br /> CONTR.LICEN E't `/ �'vM �'^� � � <br /> lioly- �9�T�q�� ,��� Ev {�s7r y,2 �-���-0 1 <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric !/ Gas Other <br /> WORK DESCRIPTIQN <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FUCTURE 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/badmop/etc.) Exhaust fan <br /> _ Backflow preventer � Heat pump <br /> Urinal Unit heater <br /> Dnnking Fountain . Boiler <br /> Floor drain ///�!!/ Refigeration <br /> _ Grease trep l�\ Woodstove <br /> Roof drains � Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�iQS <br /> I hereby certify that 1 have read and examined thls application and krrow the same to be irue and correct. All provisiona ot lawa and <br /> ordinances goveming this type of work will be complied with whether specified herein or not.The granting of a permit dces not preaume <br /> to give authority to vidate or cancel the provision of any other stale or local law regulating construction or the pertortnance of <br /> construction.That I am authorized 6y the�wner of this property to perPorm the work for wMch application is made arM 1 compy wiM the <br /> State Contr ors law . 7 RCW and 298.200 WAC. <br /> l� "l� • /D <br /> Signa o wner/Contractor/Authorized Agent Date <br />