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PERMIT APPLICATION <br /> CITY AF EVERETT PERMIT SERVICES � ` � `�v <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-I381 U— FAX 425-257-8857—www•everettwa.org n <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br /> ( .1�%�'�U' ��i2� <br /> SITE ADDRESS 7 PARCEL TAX I.D.# I PE IT B!� M <br /> ; ,- ,�`-. � �" ��� - )v �//C/7 �(.� <br /> �_. � � �_� � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION M � /���_/� <br /> DESC. <br /> OWNER ADDRESS CITV2IP PNONE <br /> TENANT NAME I CONTACT Fc:R PiRMIT PHONE <br /> E•MAIL <br /> _—��� <br /> CONTR.LICENSE p <br /> � .._ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric _Gas_Other <br /> WORN DESCRIPTION � . <br /> ;. <br /> ���,� l��� .�� u����� ����-,�z�z ��r� �.-�"� ��t(�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ A/C–air handling units <br /> Ba�htub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Waler heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher ___ Gas range <br /> Clo�hes washer __ Clolhes dryer <br /> Waler heater __ Range hood <br /> Sink (service/bar.�mop/etc.) _ Exhausl tan <br /> BackOow prevenler ,_ Heal pump <br /> Urinal _ Unit heater <br /> Orinking Founlain _ �oiler <br /> Floordrain _ Refrigeration <br /> Grease trap _ Woodstove <br /> � Rool drains _ O�her <br /> �I __ Other ___ — — _ <br /> ��, � CITY OF EVERETT LOCAL SALES TAX COOE IS J105 <br /> I -- — <br /> iI hereby certify thal I have read and examined lhis epplication and know Ihe seme to be true end correcl. All provisions of laws and <br /> oidinances governing this type of work will be compGed wilh whelher specified herein or not.The granting of a permil does not presuma <br /> �, to give authorily to violate or cancel the provision of any olher state or local law regulating consiruction or the perlormance ot <br /> Iconslruction. That I am authorized by the owner o(this property to perform the work for which application is made and I comply with the <br /> Slale Coidractors Law 18 27 RCW and 296200 WAC. <br /> � , , �� `1 IJ <br /> �naWre of Owneri%C ira ot4 UAuI orizeJ genl De� <br /> �' _ <br /> / i <br /> ` --- <br />