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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES �����- '-°��7� <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 I�0�'U 7-O Z?j <br /> SITE ADDRESS _ PARCEL TAX I.D # PERMIT# <br /> i , �: � � .- r�� ��C1 � ' � �. �' . - <br /> . . . ��'l_` -��. L UJl U��� <br /> LEGAL LOT NO. BLOCK TRACT OR SU9DIVISION i! <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> u ? ��. � � ��"� L� � j �r . �: �- ,� . i • <br /> TEI�ANTNAME � CONTACTFORPERMIT ^PHONE <br /> i - i <br /> � . � (C � / <br /> Z��C�',.1 :- _�� �- � ('� C'-�{'. ���C.�'S/1 ;�P E-MAIL .,��n ',)' Jv l-C� Y <br /> CONTRACTOR � ADORESS CINIZIP PHONE <br /> �..'Z�,-_ ,._ �' .v.. �� _!_ � :� 1�1:;ZZ t,; ', / �� !�_� < !Va � /UE,-f1 <br /> CONTR.LICENSE# _- � <br /> . -, � , � l � 9��Z /o � <br /> � ' i-�-ri5 ., :�:k"� 2 •� �-1 �t�� <br /> USE OFBUILDING HEAT SOURCE CQ�o�r pf�ICE"OF WORK <br /> '-�ectric _Gas Other � ' - <br /> — — G�1._i ) <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kitchen sink &disposal Gas fireplace <br /> Dishwasher Gasrange <br /> _ Clothes washer Clothes dryer <br /> _ Water healer Range hood <br /> Sink(service/badmop/etc.) Exhausl fan <br /> Back(low prevenler i�eat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Re(rigeralion <br /> Grease trap _ Woodstove <br /> Root drains Other <br /> Olher <br /> i � , <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined lhis applicalion and know the same to be lrue and correcL All provisions of laws and <br /> ordinaces goveming lhis type o(work�vill be complied with whether specified herein or not.The granling of a permit does not presume <br /> lo give aulhority lo violate or cancel Ihe provision o(any other stale or local law regulaling construction or the peAormance of <br /> conslruction.That I am aulhorized by the owner of this property lo pedorm lhe woik for which applicalion is made and I comply with ths <br /> State Contractors'Law 18.27 RCW and 296.200 N/AC. <br /> . _/���c�� ..J.�.y/....u.:... �j <br /> _�— � ' ' "- � e "�^�' � ��` �( Q� ' � /\ <br /> Sign��ure of 0 ontrac�or/A�thorized Agent Dal�" <br /> L <br />