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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM ��l6 `-/V <br /> SITE ADDRESS PARCEL TAX�.D.# PERMIT# <br /> � o � cc.%-h{ --/ �, - . _ M� bug- vac� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. � ,: N <br /> OWNER A D ES � CITYIZIP PHONE <br /> �lu/7�1�.-:, LCG��--' � cl. �m ``'. -=L�.�v�jC `/ �'i.��l� �` �-ti�j" z S�/.Z � <br /> TENANT NAME CONTACT FOR PERMI;' PHONE <br /> �.��2m r E•MAIL <br /> R p E IZI P <br /> CONTR.L19ENSE N �"-l <br /> �� [�.; t-r�.� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> >o <br /> _Etectric �Gas_Other �� C u L �' <br /> WORK DESCRIPTION f � ! �- � <br /> i,��i,.�;'� �-.� cs C� ,-v,. � — "-t i..:_. � . ��= � ,� .-�r� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel All:-air handling unils <br /> 6alhtub � Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Showcr � Water heater <br /> Kilc,�en sink 8 disposal _ Gas fireplace <br /> Disl�washer __ Gas range <br /> Clothes washer _ C�othes dryer <br /> Waler heater _ Range hood <br /> Sink(service/badmop/etc.) _ Exhaust fan <br /> BackOow preventer _ Heat pump <br /> Urinal _ Unit healer <br /> _ Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Olher — <br /> I <br /> CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br /> I hereby certify thal I have read and examined this applicalion and know Ihe same lo be irue and correcL All provisions of laws and <br /> ordinances goveming this type of work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br /> to give aulhont��lo violale or cancel ihe provision of any clher stale er!c;al lu�.•rzgutaliny consirucuon or the performance of <br /> construction. That I am authorized by the owner o(ihis property to peAorm lhe work forwhich application is made and I comply with lhe <br /> Stale Contractors Law 18.27 RCW and 29G200 WAC. <br /> ` .:_-.,� �- �'� � _ �-/6 �% C <br /> Signature of OwnerlConlractor/Au horized Agenl D e <br /> . <br />