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PtRMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, 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 ADDRESS PARCEL TAX I.D.# PERMIT# <br /> `>7� �,1�11u�� �v� I,,��'.c,r,crm �zo�, lM (��� �1 '�S <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. �.V f "1JQ 1�5 �1(7�'� �"��� � <br /> OWNER ADDR[SS CITY/ZIP PHONE <br /> L�1v,-�;:, `�" �<<� n�r�<��`rl ��1.�"� �-�le��wc�� I�e �1�1e �f- �,+?� �IZS• �`�'� �-I <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR / ADDRESS CITY2IP PHONE <br /> �W n�X,GD -�� �Dy� J� <br /> CONTR.UCENSE# nDYIa IL�]-1�)j���� <br /> USE OF BUILDING HEAT SOURCE ( CONTRACT PRICE OF WORK <br /> S�/�-- _Eleclric �Gas_Olher ��G(,�.�• �'� <br /> WORK DESCRIPTION <br /> ��---- i ;.��_� / <br /> .1�^ ` ) <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR 1T8M NO. TYPE OF FIXTURE OR ITEM I <br /> Toilet A/C—air handling units <br /> Bafhlub Forced air systems <br /> _ Lavalory(wash basin) � Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 disposal \ Gas fireplace <br /> Dishwasher Gas range <br /> Clofhes washer Cbthes dryer <br /> Water heater Range hood <br /> Sink(serviceNadmop/etc.) cxhausl fan <br /> Backflow prevenler Heal pump <br /> Urinal Unil heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TlUC CODE IS 3105 <br /> I hereby ceriti(y lhal I have read and examined this application and know the same lo be lrue and correct. All provisions of laws and <br /> ordinaces goveming lhis type of work will bc comp�ied wilh whether specified herein or nol.The granting of a permil does not presume <br /> to c�ive aulhority lo viaale or c:ancel lhe provision of any olher state or local law regui3ting consWction or ihe performance of <br /> conslruction.That I am aulhorized by lhe owner o(this property to pedorm lhe work(or which applicalion is made and I compiy wilh the <br /> Slate Contraclors Law 1827 RCW and 296.200 WAC. � j <br /> ` l� �`�,�� i. �{�;1 �/ � S /D�� <br /> SignaWre oFO�vner/ConfrabtodPdlCion e�Agent Date <br /> ! <br />