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1 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTEb FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL T/U(I.D.N PERMIT A <br /> . ' � �� <br /> ; � -, � ,'� i:; ?, -t;�� <br /> LEGA LOTNO. BLOCK 7AACT <br /> DESC. <br /> ONRIER ADDRE93 � , qTYIDP PHONE <br /> ' � l� .. i. , , ,1 �. l. : ,' � , � % . r „ . . `Il�, '•r �� '� �� i <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> i - <br /> ' � �; ;r' �� ( ����. � <br /> CONTRACTOR i .��' � i , , ;� -,,�,! ADDRES8 CITY/LP PHOME <br /> , . , � � . . ,q.,�. /� . � .(-.4 <br /> CONTR.LICENSE t �,- ,. � �_ � '� ����� <br /> USE OF BUILOIN6 HEAT SOURCE CONTRACT PRICE OF WORK <br /> , i , —Electric _Gas_Other � �' 4 .�' ) <br /> WORK DESCRIPTION <br /> , � ; � l ,� i ��� ;, - <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM N0. TYPE OF Fl%TURE OR ITEM <br /> Tollet A/C–air handling uni4s <br /> Bathtub Foroed air syatems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen s�nk 8 disposal Ges fireplace <br /> �ishwasher Gas renpe <br /> Clothes washer ClMhes dryer <br /> Leundry trey Range hood <br /> Sink(servicelbadmop/etc) Exhausl fan <br /> Backflow preventer Heat pump <br /> Unnal Unit heater <br /> Dnnking Fountain Boilar <br /> Floor drain Refngeration <br /> _ Grease trap Woodstove <br /> Roof drains � Othar �e�.� � �"K 5 <br /> Other <br /> CITY OF EVERETT LOCAL SALE9 TAI(CODE IS�706 <br /> I hereby on��ary Ihat I have rsad and ezeminetl this applicalion end know the asme to be true end conact. All provisions ol laws end <br /> or0inacas goveming this lype of wcxk will be complied with whether specified herein a not.The granting of e pertnH daes rrot presum�, <br /> to glve authority to violate or cancel tt�e provision of any other stale or local law repulaUng oonsWc6on a�the perfortnance of <br /> construdion. That I am authorized by the owner of thia property to pertortn the wark tor which applicatan is made and I comply with the <br /> State Contractors Law 1B.27 RCW and 29fi.200 WAC. <br /> �. � 1, �/,� �� <br /> Signature� r ontradod ulhorized nt �� <br />