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PEKMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982G1 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTEU FROM 8 AM TO d PM �{ — U �� <br /> SITE ADDRESS PARCEL TAX I.D.K pPE�RM/IIT A! (� <br /> j\� �tr� W 'vl !�/ � ! � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 CITYIZIP PHONE <br /> Sl�ell G�r,.S 1S��i c�,�h ,, I{,,e F�>�r�cl+ �zs 33S �i� � <br /> TENANT NAME CONTACT FOR PERR7IT PHONE <br /> CONTRACTOR K A�,,, cy �..�piY.�i�„ AD��E�C w �Q��� CITY2IP PHONE <br /> � ���CQ. Di �JC.�o� s�l�' ���Z <br /> CONTR.LICENSEp �17Ch6�h�3h �7 �7- i�C� <br /> I<-A( r-�G H+e c 6!� P D <br /> USE OF BUILUING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Olher <br /> WORK DESCRIPTION '� <br /> "� . �� , ,;w,�� ,_�__ — t-=� e" �y � � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUHE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet NC-air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal I Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/6admop/etc.) Exhausl(an <br /> BackOow prevenler Heal pump <br /> Urinal Unit healer <br /> Dnnking Fountain Doiler <br /> Floor drain Relrigeralion <br /> Greaso trap Woodstove <br /> Rooi drains Other <br /> Olher <br /> CI7Y OF EVEREtt LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be Irue and correcl. All provisions o1 Iaws and <br /> ordinaces governing this lype oi work will be complied wilh whclher specified herein or nol.The grenting of a permit does nol presume <br /> lo give authority lo violate or cancel the provision of any other stale or local law regulating construction or the poAormance ot <br /> construclion.That I am aulhorized by the owner of ihis property lo peAorm the work tor which application is made and I comply with the <br /> Slate - nlractors Law 1827 RCW and 296200 WAC. <br /> ����- 4• ti -u � <br /> Signalure of OwnedContrac r/Aulhorized Agent Date <br />