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r — - <br /> PERMIT APPLICATION <br /> CI'fY OF EVERETT �ERMIT 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 ADDRESS PARCEL TAX I.D.# ���� � <br /> .e �— C Pil �Q�-�- �/�. <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE (f,l(.., <br /> l <br /> � ��d <br /> L �ti. 2 i S' -f<_ �t,,.� (c�(=f�K � -��Z- � <br /> TE ANT NAME CONTACT FOR PERMIT PHONE <br /> �7��` �L'(�id��"� � U.�'-', �Z� � �"I%ui� ��f= 7s�S'- o�Go <br /> E-M IL <br /> CONTRACTOR ADDRESS CITYIZIP PHON <br /> w ��t�- �^�-9 ��< < r � o � Nwy 75 � !a �yh��„�-�, w,� Y�'� <br /> CONTR.LICENSE# G c ��ZS._ 7 (i i- _ o'� (, J <br /> (.�l.�'fi.e i-1 i 9 7 .J- r <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Eleclric _Gas_Olher (� S'�% � <br /> WORK DESCRIPTION f J � q�� ��� ��`�� y� ,e�j�•1�� S�",� <br /> ��-e. �x ls <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ aC-air handling units <br /> Balhlub _ Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower _ Walerheafer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clothes dryer <br /> Waler healer _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> 6ack(low prevenler _ Heal pump <br /> Urinal _ Unil healer <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Re(rigeration <br /> Grease trap _ Woodslove <br /> Roof drains _ Olher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y thal I have read and examined this applicafion and know lhe same lo be lrue and correcL All provisions of laws and <br /> ordinaces governing Ihis lype of work will be complied�vilh whether specified herein or noL'he granting of a permif does not presume <br /> to give authority to violate or cancel lhe provision of any other stale or local law reguialing construclion or the performance of <br /> construction.Thal I am aulhorized by the owner o(lhis properly lo perform lhr•.vork for which application is made and I comply with lhe <br /> Stale Conlraclors Law 18.27 RCW and 296.20 WAC. � <br /> f I �-����'� �� ��l �� <br /> SignaWre of Ow er ontracl d i t onzed e Dat �� <br />