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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32U0 CEDAR STREET, EVERETT, WA 58201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � ���� <br /> SITE ADD ESS PARCEL TAX I.D.N PERMI <br /> � ��1 > �oi.�; � D 3 � /v� � O/ 7��� Q 7G�0/3 <br /> LEGAL l0T NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER/ ADDRESS CITY/ZIP PHONE <br /> j K" o��f l� <br /> TENANTNAME CONT CTfO PERMIT PHONE $ <br /> S,��;�a� E.�?��� <br /> -�— - <br /> CONTR.UCENSE M ���)��� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Elociric _Gas_Olher <br /> WORK DESCRIPTION <br /> �y��, a <br /> PLUMBING MECHI',NICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel __ NC—air handling unils <br /> E3alhtub _ Forced alr systems <br /> Lavalory(wash�asin) _ Gas piping <br /> Showr.r ___ Watm hoaler <br /> Kilchen sinV.& Aisposal _ Gas lireplace <br /> Dishwasher _ Gasrange <br /> Clolhes washer _ Clo�hes dryor <br /> Walm heater _ Range hood <br /> Sink(servicelbarlmo�Netc.) __ Exhausl fan <br /> Backflow preventer _ Heal pump <br /> � Urin21 _ Unil heater <br /> Drinking Founlain __ Doilor <br /> flourdrain _ Relrigeralion <br /> � Grease�rap _ Woods�ove <br /> Rool drains _ Olher _ <br /> . _— O�her _— — -- <br /> CITY OF EVERETT LOCAL SALES iAX CODE IS 9105 <br /> I hereby cerilily thal I have read and examin�d Ihis application and know lho same�o be�rue and currecl. All provisions of laws and <br /> urdinaces yovernin�Ihis lypo ol work will be complied wi�h whe�hor specified herein or noL The�renling o(a permi�does nol presume <br /> In�ive authority lo violate or cancel Ihe provision of any other stale or local law regulating consWction or the peRormance ot <br /> conslruction, Thal I am aulhorized by Ihe owne�r ul this property to perlorm the work for which application is made and I comply wilh Ihe <br /> Stale Contraclors Law 7827 RCW and 296.200 WAC. <br /> S�gnaturc of OwnedContraclodAuthorized Agenl Dale <br /> I . . .. . ... . . . _ ---- <br />