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F- cR11�IIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32C0 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 � --�—/U <br /> SI�E�DD�SS ��\ PARCEL TAX I.D.N �i MOI�Ta _ M I <br /> .��J (j lJV <br /> LEGAL LO�NO. .BLOCK TRACT OR SUBDIVISION N <br /> D[SC <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �2 2�,a�1 C�;u.v„c� 3�3v Cb� �-T <br /> TENANT N E /� CONTACT POR PERNiIT PHONE �S t�-(O� �� <br /> U�fYC���J�t���j !/ (�7�IVi�`� � ln,c�i'v ��"���1 E-MAIL�e.S� .4.Mt <br /> �au�a�sa� o� 7fvri�—�aa� <br /> i <br /> CONTR.LICENSE# Lef��l,�s� rj�SDS p� � <br /> USE OF BUILDING HEAT SOURCE COf�I'RACT PRICE OF WORK � <br /> '�{�t J _Eledric _Gas�Other ��p v� <br /> I <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ A/C -air handhng uni�s <br /> Dalhlub Forced air syslems <br /> � Lavatory (wash basin) _ Gas pipmg <br /> Shower Waler healer <br /> Kitchen sink&disposal Gas fiieplace � <br /> Dishwasher Gas range <br /> Cbthes washer _ Clothes dryer � <br /> Water heater Range hood <br /> Sink (service/bar/mop/etc.) , Exhaust fan <br /> 6ackllow prevenler Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain 8oiler <br /> Floor drain Re(rigeration <br /> Grease Irap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS�105 <br /> I hereby certify that I hare read and examined this application 2nd know lhe same lo be true and correct. All provisions ot laws aod <br /> ordinances governing lhis lype ot work will be complied with whether speclfied herein or noL 7he greMing of a permit does not presume <br /> to give authonly to violate or cancel the provision of any other state or local law regulaling ccnstrudion or ihe periormance of <br /> construction.That I am authorized by�he owner ol Ihis property to pertorm Ihe work for which application is made and I cumply with the <br /> Stale Contr o�t rs�aw 18 7 R and 2�JG200 WAC. <br /> l�� � D� �� ��U <br /> Signature of OwnedContractorlA thonzed Agent ' ate <br />� - <br />