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P�RMIT APPLICATI� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-2F7-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM (, ., S --0� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT ii <br /> :1c:. <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> E ��/ <br /> T NANT NAME� I CONTACT FOR PERMIT PHONE <br /> I <br />' CONTRACTOR ADDRESS CITY2IP PHONE <br /> � <br /> CONTR.LICENSE p ��� ! ( �`� �.//� /�'��`�� 'J <br /> J C7— <br /> USE OF BUILDING HEAT SOUiCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other �6fJ`� _ <br /> WORK DESCRIPTION <br /> ���� �,�^�,.�.�L�G^ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C-air handling units <br /> Balhlub Porced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Walerheater <br /> Kitchen sink 8 disposal __ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer _ Clothes dryer <br /> Waler heatr,r __ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan �� C,� � I <br /> 6acktlow prevenlcr __ Heat pump , �D r„�d f� <br /> Urinai _ Unil heater (�,�.p�- I <br /> _ Drinking Fountain _ Boiler �, �� �if S <br /> Floordrain _s Refngeralion ��ft�t'�` <br /> Grease trap _ Woodslove , <br /> Roo(drains Other <br /> Other <br /> (:ITY OF EVEP.ETT LOCAL SALES TAX CODE IS J705 <br /> I hereby ceritify that I have read and examined this application and know ihe same to be true and correct. All provisions o(laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or noL The granting of a permil does nol presume <br /> lo give aulhorily lo violale or cancel lhe provisinn of any olher state or local law regulating construclion or the peAormance of <br /> conslruclion.That I am authorized by ihe owner of t��s property to peAorm the work for which application is made and I comply witi�the <br /> Slate Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> Signalure of Owner/ConlraclodAuthorized Agent Date <br />