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PErtMIT 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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.il PERMI # I <br /> � '� (- ,' • 5 2' <br /> i - <br /> LEGAL LOTNO. BLOCN TRACT � , <br /> DESC. ' - � � � � �� � ' � <br /> OWNER AD�RE55 CITY/ZIP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> . � _ . • - �i . � � � , , <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> / . ', .-r� _� ;� ,'';� r; ,.J ,, ; . E;<< �(�- .Y�'/� t�'�_0% ��5�5�'/y� �" <br /> CONTR.LICENSE M �� <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> - � Electric Gas Other ��,J, <br /> WORK DESCRIPTION <br /> _ � �/. , . , /i��•I� � '�.' / ! 7'"� , <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C–air handling units <br /> Bathtub Forced air systems <br /> Lavatory (wash basin) _ Gas piping <br /> Shower Walei heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher _ Gas range � � <br /> Clothes washer _ Clothes dryer i <br /> Laundry tray _ Range hood <br /> Sink (service/bar/mop/etc.) _ Exhaust fan <br /> Backilow preventer _ Heat pump , <br /> Urinal Unit heater <br /> �. Drinking Founlain _ Boiler , <br /> ! Floor drain Refngeration <br /> Grease trep Woodslove <br /> Roof drams Other <br /> ' Other <br /> CITY OF EVERETT IOCAL SAlES TA%CODE IS 7105 <br /> I hereby ceritify that I have read and ezamined this application and know the same to be true and corracl. All provisions of laws and <br /> o�dinaces goveming this type of work will be complied with whether specified herein or not.The granting of a pormit does not presume <br /> to give authoiity to violate or cancol the provislon of any other state or!ocal law regulaung ccnstructlon or the peAormance of <br /> construclion.That I am �uthorized by the owner of this property to peAorm the work for which application is made and I comply with the <br /> Slate Contractors Law �D.27 RCW and 296.200 WAC. <br /> S�gnaWre ot Owner; ontr2c�onAu�honzed Agent � / ale <br /> �z � <br />