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P�RMIT APPLICATIO�� <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 /> APPLICATICNS ARE ACCEPTED FROM 8 AM TO 4 PM � —I �`�O 7 <br /> SITE ADDRFESS / ) � PARCEL i AX I.D.p PE IT# <br /> �,� G '�_� �A �1 ,47 ', C I ���1�— <br /> LFGAL LOT N0. BLOCYi TRACT — <br /> DESC. <br /> OWNER A�DRE55 CITY2IP PHONE <br /> TENANT NAME,' CONTACT rOR PERMIT PHONE <br /> r�� j <br /> ,�,�/lC�� �' L�C%�1�� <br /> CONTkACTOR ADDRESS CIN21P PHONE <br /> CONTR.LICENSE N �i�)�/��'�L�� <br /> L <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> [leclric Gas_C�Ilier <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � Toilel _ A/C—alr handling unils <br /> Oathtub Forced air systems <br /> � Lavatory (wash basin) _ Gas piping <br /> Showor Water haatar <br /> Kilchon sink d disposal _ Gas fireplaco <br /> Dishwasher Gas ranye <br /> Clolhes washer Clothes dryor <br /> Wator hoator Range hood <br /> 5ink(servica/bar/mop/ulr..) _ Ezhausl lan <br /> Backflow praven�er _ Heal pump <br /> Urinal Unll hoa�or <br /> Orinking Fountain _ Boller <br /> Floor drain Relrigeratlon <br /> Groaso trap _ Woodstove <br /> Roo(drains Other <br /> Othar <br /> CITY OF EVERETT LOCAL SALES TA%CODC•IS 3105 <br /> 1 hereoy ceriti(y thal I hava read and ozaminod this a��plication�nd know lho same to be lruo end cortect. All provisions of laws and <br /> o�dinaces governing lhis typo of work will be compliod wilh whether specified herein or not.The granling of a permit does not presume <br /> to givo authority to violato or cancel tho provislon of any olher slate or local law regulaling conslruction or the peAortnance a( <br /> constructioa Th�l I am authorized by iho ownor o(Ihis property to porlorm lhe work for which applicalion Is made and I comply wllh the <br /> Stato Conlraclors Law 10.27 RCW �nd 296.200 VJAC. <br /> � <br /> � �__<<<_ < <' <br /> nalure of Ow dConlrector/Authonzed Agent Date <br /> ! <br />