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PEKMIT APPLICATIOIv <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 FM �� �-6�� <br /> SITE ADDRESS PARCEL TAX I.D.# �RMIT# <br /> l°I/ S �,;cr-'Dw�/ v �'`�3�r34 � cvuc� p '- �1-� <br /> L[GA LUTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADURESS CITY2IP PHONE <br /> N� � ,_� i r �, ��-'� ���}s ��'- � s7Nr iv�ar.'y1��1cc� � . 9�z,� �:�� �s�-�� ,: <br /> TENANTNAME CONTACTFORPERMIT /� PHONE <br /> /n/ ( '/ n <br /> i�� -�/M1'�� `.�� '7 l' r�'� (�`' � � 7 <br /> CONTRACTOR ADDRESS % CITY2IP PHONE <br /> � <br /> CONTR.LICENS[t! � <br /> GU/�J✓,✓, <br /> USE OF BUILDING ' HEAT SOURCE CONTRACT PRICE OF WORK <br /> LOMI'l� _Eleclric _Gas_Olher ��� �L��n'- <br /> WORKDESCRIPTION ��= CGV�r EXI �`�'ll��j AW/�1lay (,v �'t"� �A1�"tr1� S%��L <br /> j:�� {- w I��,, �:/��a c c- �,y� .S ;G-i�l <br /> PLUMBING MECHANICAL <br /> ryp, TYPE OF FI;(TURE OR ITEM N0. TYPE GF FIXTUR[OR ITEM <br /> 7oilel A/C-air handling units <br /> Dalhtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Disliwasher Gas range <br /> Clothes washer _ Clothes dryer <br /> Waler healer Ranc�e hood <br /> Sink(service/bar/mop/elc.) _ Exhausl tan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Relrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Olher __ .— <br /> CITY OF EVERE:T LOCAL SALES TAX CODE IS 3105 <br /> I hereby centify fhat I have read and exami��ad lhis applicalion and know the same to be We and correct. All pro��isions of laws and <br /> ordinaces goveminc�lhis lype of work will be complied wilh whether specified herein or r.,,L The granting of a permit doos ncl presume <br /> to give authoriry lo violale or cancel the provision oF any other state or Iocai law regulating consWction or the per(ormance of <br /> ronstructiop:�That I am authorized by lhe owner of lhis property lo per(orm lhe work(or which application is made and I compiy wilh the <br /> Slale Co�9clors Law 1827 RCW and 296."<00 WAC. <br /> /�---- -%l �,'_�` .{,�`. <br /> �.'.�+ -�" _""`� � <br /> Signature of Owne�/Contractor/Aulhorized Agent Date <br /> 'IZ <br />