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P�RMIY APPLICATIU�V <br /> CfTY OF EVERETT PERMIT SERVECES <br /> 3200 CEDAR STREET, EVEREIT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED i rZOM 8 AM TO 4 PM <br /> SITE f�DpR�� ����/ r�/, f(r` ^ PA�L TAX I.D.# P�RMIT ff <br /> j �t , C �i� 7�J41�/Q/� 1� ��Lb� <br /> LEGAL LOT NO. BLOCI, / TRACT <br /> DESC. v <br /> OWNER ADDRESS CITYfZIP PI10NE <br /> TENANT NAME CONTACT FOR PF,RMIT PHONE <br /> COIJTKACTOR ADDRESS CITYIZIP PNONE <br /> CUNTR.LICENSE tl <br /> USE OF BUILDING HEAT SOUftCE CONTRACT PRICE OF WORK <br /> Eleclric Gas Other <br /> WORK DESCRI�'TION ' <br /> l� �ti'�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ItEM <br /> icil�t A/C—air h�ndling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Showr.r Waler heater <br /> Kilchen sink&dir�osal Cas firepiace <br /> Dishwasher Gas ranr; <br /> Clolhes v�asher Clothee dryer <br /> Waler healer Range hood <br /> Sink(service�bar/mop/elc.) _ Exhai�st fan <br /> _ Backflow preventer _ Heat aump <br /> Urinal Unit I�eater <br /> Drinking Fountain Boile <br /> Floor drain Refri 3eration <br /> Greasetrap _ Wooistove <br /> Roof drains Other <br /> Olher <br /> —I <br /> CIN Of EV[RETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify Ihal I have read and examined thi�application and know the same to be c�ue and correcL Ail provisions ot laws and <br /> ordinaces goveming this type of work will be complied with whelher specilied herein or noi. �no granting of a permit does not preswne <br /> to give aulhoriry to violale or cancel Ihe provision of any olher state or local law regulating conslruction or lhe performance ot <br /> construction.Thal 1 am authorized by lhe owner o(this property to per(orm the work for which applicalion is made and I comply wilh the <br /> State Conlractors Law 1f1.27 RCW and 296.200 WAC. <br /> Signalure o(OwnedContraclor/Authonzed Agent Dale <br />