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PERMIT APPLICATION <br /> CITY OF E!/ERETT PERMIT SERVICES `r� a�`c,� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 c� -- 7 <br /> 425-257-8810— FAX 425-257-�857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �g0703-OZI,�� <br /> SITE ADDRESS PARCEL TAX I.D.# P�MOI���_Q� <br /> Z ' � � <br /> LEGAL LOT NC. BLOCK TRACT OR SUBDIVISION# <br /> �ESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> 1 E-MAIL <br /> CONTRACTOR u�{� i Y,A¢,DRESS CITYIZIP PHONE <br /> .v �7 <br /> CONTR.LICENSE p <br /> ?,L �us� �� � ( �� <br /> USE OFBUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Olher <br /> WORK DESCRIPTION <br /> � <br /> �,>>� <br /> PLUMBING MECHANICAL <br /> NO. TYPF OF FIXTURE OR ITEh1 NO. TYPE OF FIXTI;RE OR ITEM <br /> Toilet _ A/C–air handling unils <br /> I3alhtub Forced,�ir sysfems <br /> '� Lavalory(wash basin) _ Gas Niping <br /> Shower Waler heater <br /> � Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> _� Water healei _ Range hood <br /> Sink(service/bar/mop/etcJ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Uni!healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> _ Grease trap _ Woodstove <br /> Roci drains I Other <br /> Other <br /> I <br /> CITY OF�EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> I hereby ceri�ify lt:at I have read and examined this application and know the same lo he Uue and currecL All provisions of laws and <br /> ordinaces goveminc�lhis rype ot work eiill be complied wilh whelher speci(ied herein or nol The granling of a permit does not presume <br /> to give authority to violale or cancel the provision o(any oLier stale or ior.al law regulaling�onstr�ction or lhe performance of <br /> conslruclion.That I am aulhorized by lhe owner of lhis properly lo perform Ihe werk for which application is made and I comply wifh tne <br /> State Contra�lors� <✓18.27 R_Cyy an 96200 WAC. <br /> I � P �Pir��l�� - <br /> j >ignatur of OwnedContract r/Authonzed Ac�ent Date � 1 <br /> ��/ <br />