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PERMiI_T APPLICATION <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 <br /> SITE A�DRESS PARCEL TAX 1.0.# P MIT# <br /> 2-`�� a Zq Z 3 Co�\�, ��•e • -'Dy '� <br /> LEGAL i.OTNO. BLOCK TRACTORSUBDIVISIONN <br /> DESC. <br /> OWNER ADDRE55 CITYIZIP PHONE <br /> G�� 1e� ��ara.�`e i 2.�2� Cao��4 �i e SU�� �om �va-e.'}� ,gPZc,� (ub) 3SZ9�/1. <br /> TENANTNAME I CONTACT ORPERMIT PHONE <br /> ,y. T'hC�M� �� C E-MAIL <br /> ONTRACT R ADDR S ITY2� HO E <br /> T.�0.N� <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> T `� CJUg � �J\ v��� _Electric _Gas_Olher <br /> � 'ta <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Dalhlub Forced air sysiems <br /> _ Lavalory(wash basin) _ Gas piping <br /> Shower Wata healer <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> � Dishwasher _ Gasrange <br /> Clothes washer Cbthes dryer <br /> Water healer Range hood <br /> Sink(service/b��r/mop/elc.) _ Exhausl fan <br /> X BackOow prevenler _ Heatpump <br /> Urina� Unit healer <br /> Drinking Fountain Boiler <br /> ,�j� Floor drain _ Re(rigeralion <br /> Grease lrap _ Woodslove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i hemby ceritify thal I have read and examined this application and know the same to be true aad correct. All provisions of laws and <br /> ordinaces goveming Ihis lype of work will be complied wilh whether speci(ied herein or nol.The granting o(a permit does not presume <br /> lo give aulhonty lo violate or cancel the provision of any other state or local law rec�ulaling construclion or the periormance of <br /> construction.That I am authorized by the owner of Ihis properry to perform the work for�•hich applicalion is made and I wmpiy with lhe <br /> Sl�e Cantr,�clors Law 18.27�and 296.2�WAC. <br /> `� �.�-"'7 Lti/!l _`�1�3� <br /> Signalw�. OwnedCont ctor/Auth"nz ,�7lgenl D�te <br /> G' L�' <br /> � <br />