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pcRMIT APPLICATIt�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA�8201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �' �as- 0 7 <br /> SITE ADDRESS PARCEL TAI(I.D.# PERMIT A� <br /> ,�y3 e�« �� r�'°���`�S <br /> LEGA LOT N0. BLOCK TRACT OR SUBUIVISION M I <br /> DESC. <br /> OWNER ADORESS CITV2IP PHONE I <br /> y�5-�58 - �, <br /> f�c.��� � A�rr�-N�t;hwl�.r �y3�C�r��S� E �Pre-�f198�o1 �i�[�� <br /> TENANT NAME ( CONTACT FOR PERMIT PHONE(��L_�,(�-yG��� '. <br /> �J <br /> �_ .(.�l�G N�G�✓��i� E-MAIL LL1/ C��YI�G��(�• . <br /> RESS �'1 <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> E��c�ric Gas Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIxTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) _� Gas piping <br /> Shower _�_ Wa�o�heater <br /> Kitchen sink 8 disposal � Gas fireplace <br /> Dishwashor Gos rango <br /> Clothes washer Clolhes dryer <br /> Waler healer Range hood <br /> Sink (servico/bar/mon'eta) _ Exhaust(an <br /> Backflow prevenler _ Heal pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boller <br /> Floor drain Rafrigoration <br /> Grease trap Woodstova <br /> Roof drains � Olher_____ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> I hereby coritify that I have read and examined lhis applicalion and know the same to be true and correcl. All provisions o(laws and <br /> ordinacos govoming Ihis�ype ol work will bo complied Ilh whelher spoci(ied herein or noL Tne granling of a permit does nol presume <br /> lo give aulhorily lo violatr.or cancel ih�n provision ol y othor stale or local law regulating construclion or the peAormance of <br /> conslruction. That t am aulhorized by the owner ol is pruperty to pertorm the work for which application Is made and I comply with the <br /> St te Coniractors Law 18.27 RCW and 2�16.200 AC. <br /> ��� ��� � ,, <br /> Signature o1 Ownor/Contrector/Au orlie gent Date <br />