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PtRMIT APPLICATIC�N <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 /0 � ���-O> <br /> � $ITE ADDRESS PARCEL 7A7(I.D.# PERMIT# - <br /> /V ? `1�S �oib ,�ve <br /> LEGAL l0T N0. BLOCK TRACT OR SUBDIVISION il <br /> DESC. <br /> OWNER ADDRE55 CITY/ZIP PHONE <br /> TENANT NAME I CONTACT FOR PERMIT .ONE <br /> \ P /n �'ZI �•MAIL <br /> CO TRAC ADD SS C17 � PHONE <br /> �CONTR.LICENSE i! ���> �1t-+�1 �" I� I�^I I/Q <br /> I � "1 JJ V � U <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric _Gas_� �r ��tJ� C� <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURG OR ITEM NO. � TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handlinc� units <br /> Bathlub Forced air systems <br /> Lavalory(wash basin) � Gas piping <br /> Shower W aler healer <br /> Kilchen sink 8 disposal _ Gas(irepiace <br /> Dish�vasher Gas rangc <br /> Clolhes washer Clothes dryer <br /> Waler heater _ Ranc�e hood <br /> Sink(service/banmop/elc.) _ E rhaust fan <br /> Backflow preventer _ Heal pump <br /> Urinal __ Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodslove <br /> Roo(drains Other <br /> Gther <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this application and know tho same to be true and correct. All provisions ot laws and <br /> ordinaces governing this rype of work will be complied wilh whether specified hcrein or not.Tho granting of a permil does not presume <br /> lo give authonty to violate or cancel Ihe provision of any other state or local law regulalinc�construclion or the pedormance of <br /> conslruclion. That I am aulhorized by the owner o(this property to pedorm lhe work for which appiiwtion is made and I comply wilh lha <br /> State Contr'aclors Law 18.27 RCW and 296.200 WAC. <br /> � <br /> r.� <br /> ,, i� � L <br /> � - <br /> Si�nature o(OwnedConlractor/Authorized Agent Dale <br />