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PcRMIT APPLICATIC�N <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 PM � `- 9 "� � <br /> SITE ADORESS /� PARCEL TAX I.D.# I PERMIT p <br /> ����� G�Sr''1 /CC� � MU�ao�-o�2 <br /> LEGAI LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> TENANT AME CONTACTFORPERMIT PHONE <br /> / V '��l/ / ���� -- — . <br /> CONTRACTOR /�r�,r� ��.�.��� AUDRESS CITY2IP PHONE <br /> L <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���c' _ _Electric _Gas_Othor <br /> WORK DESCRIPTION <br /> � r� �-���� �.ii�� j � <br /> > / <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEM NO. TVPE OF FI%TUR� �R ITEM <br /> Toilcl _ A/C—air handling units <br /> Bathtub ForceJ air systems <br /> Lavatory(wash basin) � Gas piping <br /> Shower W eter hea�er <br /> Kitche�sink R disposal � Gas(ireplac3 <br /> Dishwasher _ Gas range <br /> Clothas washer _ Clothes dryoi <br /> Walen c�alor _ Rango hood <br /> Sink(servirelbar/moplelc.) _ Ezhausl tan <br /> �ackflow preven�er _ Heal pump <br /> Urinal _ Unit healer <br /> Drinkinc�fountain __ Boilor <br /> Ploor drain _ Relrigeration <br /> Grease Irap _ WoodSlove <br /> Roo(drains _ Othor _ <br /> Other _ — <br /> GTY OF EVERETT LOCAL SALES TAl(CODE IS 3105 <br /> I herety cerility Ihal I have read and examined Ihis applica�ion and know lhe samo to be truo and correcL All provisions ol laws and <br /> ordinaces govr,ming lhis lype ol work will be complied wilh whethor spocified horein or nol.The granling ol a permi�does not presume <br /> to give aitlhorily to��iolale or cancel Iho provision o(any other state or local law regulating construction or Ihe pedormance ol <br /> construclion. Tl�at I am authorized by tlio ownor of lhis property to porform ll�e work lor which application is made and I comply with the <br /> Slate Conlractors Law 18.27 RCW id 29G.200 WAC. <br /> � . . /� �/- 09- G <br /> SignaWro o Own rlCqrdraclor Aulhorized Ac�ent Dale <br /> I <br />