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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FPX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br /> SITE A7DRESS � PARCEL TAX I.D.# PERM/1I�T# <br /> �/�%��5�' C'/C�i� /Jl9u<'i'l /�li //( UL�� �� L, <br /> � <br /> LEGAL LOT N0. BLOCK iRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> i <br /> 7� ��� ��, �-,�, �/�%� //�,��>,�-����,> ��.� ,��t- ���� �r,��-Y��-a3�? r <br /> TENANT NFj[dE CONTACT FOR PERMIT PNONE <br /> l Il / <br /> 'J 4� �`i C^C�1 G�� E•MAIL <br /> NTRACTOR AODRESS ITY21P H <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> X Eleclric _Gas Olher ��,5�(� <br /> WORK DESCRIPTION <br /> / � <br /> i)S /�/ /)`E�L' IIE /! � ��.'���':> .'�..tc,� �—(r��i`[; L��1�1i1Cc- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handlinc� unils <br /> Balhtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitclien sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Ciolhes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/etc.) _ [xhausl fan <br /> Backllow preventer _ Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Fioor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE 19 3105 <br /> I hereby cerilify thal I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing fhis type o(work will be complied wilh whether specified herein or noL The granling of a permil does nol presume <br /> lo give aulhority to violale or cancel the provision of any olher state or local law regulating consWclion or the performance of <br /> construction.Thal I am authorized by the owner of this property lo perform the work for which application is made and I comply with lhe <br /> Statc Contractqrs Law 18 �7 R;i`�%an 296.200 WAC. <br /> `l, /�,i ,��'" � %/%O� <br /> 4"l/C«-r��r(.��,s �c �z: <br /> Si�nalure o(OwnedConlractor/Aulhorized Agent Date <br />