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( <br /> PERMIT APPLICATION <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 /> /C --�3 -o� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ..,Z�, ,� S/Nb�3°"� l)o7/o�Guy <br /> LEGAI LOT NO. bLOCK �TRACT OR SUBDIVISION p <br /> DESC. <br /> OW ER J ADDRESS CITYIZIP PHONE <br /> ' ; 1c� 236�t-���aA� S �(e,.,�c�A9�a�L <br /> TENANTN E CONTACTFORPERMIT PHONE <br /> E•MAIL <br /> --� —�_ <br /> CONTR.IICENSE N (�/lit/C�� / ��� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Flectrir, Gas Otner <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF fIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilcl A/C-air handling units <br /> — p�p����� � Forr.ed air syslems <br /> Lavalory(wash basin) Gas piping <br /> _ Shower �, Waler hea�er <br /> Kitchen sinh 8 disposal =�__ Gas lireplace <br /> Dishwasher Gas ranc�o <br /> Clolhes washer Clothes dryor <br /> Water hoater Rango hood <br /> Sink(service/barlmopleta) Exhaust lan <br /> Backflow provenlcr _ Hoal pmnp <br /> Urinal _ Unit healer <br /> Drinkin�Faun�ain _ Boiler <br /> Floor drain Rolrigoration <br /> Grease irap _ Woodslove <br /> Rool drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby corilify Ihal I havo road and ezaminod Ihis application and hnow iho samo to be truo and correct. All provisions of laws and <br /> ordinaces goveminy Ihis lype ol work will be complied wilh whether spocilied horein or nol.Tho pranting o(a pormil does nol presumo <br /> to c�ive �ulhority to violatr.or cancol the provision of nny othor stale or local law re�ulaling consVuc�ion or�he podormance o( <br /> conslruction. That I a authorized by tho owner of this proporty to peAorm tho work lor which applicalion is mado and I comply wilh tho <br /> Slale Conlraclors Law 8. 7 RCW and 2'J�.200 WAC. <br /> � Q � a <br /> Signaturn wned tra dAuthonzed Agent ale <br /> � <br />