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FcRMIT APPLICATIVN � � i ;� <br /> CITY OF EVERETT PERMIT 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�DDZRESS ��D�v� PARCEL TAX I.D.M P�R i I��O' - � <br /> -TTi � <br /> LEGAL LOT NO. �BLOCK TRACT OR SUBDIVISION N <br /> oEs� a �rn'3 c�3 "[�R-r�r� p��1�1J '� EVEP.bZf" SI..l� ca3 <br /> OWNER ADDRESS CITYIZIP PHONE , <br /> �IZU�.t� GOt� �FZS �►,1,V�o6 (.�,.5 (�� ��[.T�17 tS`-3`FS] <br /> Rgz7S 3 <br /> TENANT NAME CONTACT FOR PERMIT , PHONE <br /> E•MAIL <br /> C A � OR . A DRE I Z <br /> CONTR.LICENSEA /�/L�� ,l ) <br /> L �l. � !/ <br /> USE OF BUILDING ' f(�� HEAT Sy� , CONTRACT PRICE OF WORK <br /> 7rT� ��s <br /> �` ��Electric Gas Other � � ' <br /> WORK DESCRIPTION • <br /> �,�yrj��,z� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilcl q� fVC—air handling unils <br /> � Balhlub��! _ Forced air sysiems <br /> � Lavatory (wasli basin) � 1{ . Gas piping <br /> Shower _ � Water heater <br /> _j_ Kitchen sink 8 disposal � � Gas firepiace <br /> �_ Dishwasher _ Gas range <br /> I Ciothes washer ` �_ Clothes dryer <br /> �_ Waler heater 1 Range hood <br /> Sink (service/badmop/elc.) � Exhaust fan �� , <br /> Backflow preventer Heat pump <br /> Urinat Unit heater <br /> Diinking Fountain Boiler <br /> Floor drain Refrigera�ion <br /> Grease trap Woodstove <br /> Roof drains . Other <br /> Other ` <br /> ' � CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby certify ihal I have read and examined this applica�ion and know the same to be irue and correct. All provisions of laws and <br /> ordinances goveming this type of work will be complied with whelher specifed herein or not. The granting o(a permil does not presume <br /> to give authori�y to vioiate or cancel the provision of any other slate or local law regulating consiruction or the performance of <br /> construction.That I am au�horized by the owner of Ihis property to peAorm�he work for whlch application is made and I comply with Ihe <br /> Sta�e CoMractors Law 1827 RCW and 29G.200 WAC. <br /> Signature of Ow�edContractodAuthorized Agenl Date I <br /> �L <br /> ----------- — —� <br />