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�CRMIT� APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, �VERETT, 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 /> � <br /> �'�� ;c' �Y�.s �'iG�A��/� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 CITYIZIP PHGNE <br /> TEN�T NAME � CONTACT FOR PERMIi PHONE <br /> l�,. �(.,f,�! pC{'{ /-K� li.� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# �,{ � <br /> l�-�'� �- <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric Gas Olher <br /> WORK DESCRIPTION <br /> 5�..Ctt� /,_;�-�� � Ct��'�-E��-1 � ,:t <br /> / /i <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilel AIC-air handling units <br /> Balhtub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water hraler <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/badmop/elc.) Exhausl fan <br /> Backllow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br />! _ Greaso trap _ Woodslove <br /> Roof drains Olhcr <br /> Other <br /> — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y that I have read and examined lhis application and know the same to be We and correcL All provisions of laws and <br /> ordinaces goveming lhis type of work will be complied wilh whelher specified herein or not.The granlinc�of a permil does not presume <br /> to give aulhonly to violate or cancel the provision of any olher stale or local law regule�ing consWclion or the performa�ice ot <br /> conslruction.That I am authorized by lhe owner of this preperty lo perform lho work(or which applicalion is made and I compiy with the <br /> State Conlractors Law 18.27 RCW and 296.200 WAC. <br /> i � <br /> ��:,��� c , �� � ��y �os <br /> Signature of Owner/Copt`(aclodAutl rized Agent Dale <br />