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PERMIT' APPLICATIO��I <br /> CITY OF EVEFtETT 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 AI11 TO 4 PM (/1 u�� v ' � <br /> SITE ADDRESS PARCEL TAX I.D.# ERMIT# <br /> � C��e��c� /-�V � �Ll S-�� \ c�o i 07 "C� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE ��5� <br /> �'j �=1'�� �5C'S ��J F� ST ��. � ��� 11���S <br /> TENANTNAME CONTACTFURPERMIT PHONE <br /> C'l�c`eG, _- �"`a-S—�-1�-53�3 <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 5\��,� %�y I. , �w� �ric _Gas_Olher ` 1 <br /> �� <br /> WORK DESCRIPTION �v�, � \��v� ��U�� ��`S� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURf 7R ITEM <br /> ��t_ _ A/C—air handling unils <br /> athWb Forced air systems <br /> avatory(wash basin) _ Gas piping <br /> Shower �"V�ater heater <br /> 'kitchen sink 8 disposal Gas tireplace <br /> Dishwasher Gas range <br /> Clothes washer thes dryer <br /> -WSler heater Ranc�o hood <br /> Sink(service/badmop/etc.) Exhausl(an <br /> Backflow prevenler Heat pump <br /> Urinal Unil heater <br /> _ Drinking Fountain Bo�ile_ <br /> Floor drain —�(rigeralion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y lhal I have read and examined lhis application and know the same lo be true and coRect. A�I provisions o(laws and <br /> ordinaces goveming lhis lype of work will be complied with whether specified herein or nol.The granling of a permit does not presume <br /> to give authorily to violate or cancel the provision of any olher state or local law regulating construclion or the pedormance of <br /> conslruclion.That I am aulhorized by lhe owner of lhis property to perform the work for which applicalion is made and I comply with lhe <br /> Slate Conlracl � Law 18.27 RCW and 296.200 WAC. <br /> ���-�_ �-��-�� �, <br /> Signalure of Owner/ ontraclor/Aulhorized Agenl Date <br />