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�ERMIT A!�PLICATIUN <br /> CITY OF EVERC fT PERMIT SERVICES <br /> 3200 CEDP,i2 STREET, EVERETT, W.A 98201 <br /> 425-257-8810- rAX 425-257-8857 -www.everettwa.org g—� �� � <br /> APPLICp.TIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> I2 � , a� l �r�g — a-'�- <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> � <br /> TENANT NAME � CONTACT FOR PERMIT PHONE <br /> � C�E✓1 �?�� <br /> E•MAIL <br /> CONTRACTOR I�,���k �_�YG �'�G[C ADDRESS /1��bj f�j��j CITYIZIP Y� PHONE2rT�.9�Zy <br /> r <br /> CONTR.LICENSE# �- W A <br /> �-y�,r l-�� �jrJ" Co 9d"n yz <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other J �o(> <br /> . w <br /> WORK DESCRIPTION <br /> ^I a../ L�L �-'�� 3°� ��'� S�lJ'J�>cJ��� r��r", <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Balhtub Foreed air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal Gas(ireplace <br /> = Dishwasher Gasrange ^� <br /> Clothes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/badmop/etc.) _ Exhausl(an <br /> = Backflow preventer _ Heal pump / <br /> Urinal _ Unil heater � <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeretion <br /> i Grease Irap _ Woodstove <br /> _ Roof drains _ Olher �,, ��c,i,J�.�_ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> I hereby ceriti(y thal I have read and examined this application and kn��w the same lo be We and wrrecL All provisions of laws and <br /> ordinaces governing this type of work will be complied�vith whelher specified herein or not The granling ot a parmit does not presume <br /> to give aulhonty lo violale or cancel the provision of any olher slale or local law rec�ulating construction or lhe pedormance of <br /> construclion. Thal I am authorized by Ihe owner of this properly to perform the work for which applicalion is made and I comply with the <br /> Slale Conlractors Law 18.?.7 RCW and 296.200 WAC. <br /> �/' `���°� <br /> Signalure of wnedContraclor/Aulhonzed Agent Dale � <br /> � <br />