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PcRMIT APPLICATIC�M <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 ADDRESS PARCEL TAX I.D.# P RMIT p � <br /> ;?�.� g C� luw �a ,•e � o�- DoS <br /> � LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE y�-- <br /> ��Pu�a� .� • l-�d ��cs .�aa5� �o/N�,d,� l��� fv��� 9a�3 ��6 s9ov <br /> TEHANTNAME CONTACTFORPERMIT PHONE <br /> __ E•MAIL <br /> TRA 04��,i ��-- DDRES I <br /> CONTR.LICENSE il � <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> � / <br /> ��s �c�Pry T �ct �Eleciric _Gas_Olher <br /> WORK DESCRIPTION <br /> �,/� L �� �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilcl 'ls <br /> Bathtub s <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Waler healer Range hood <br /> _ Sink(service/badmop/elc.) Exhaust fan <br /> Dackflow preventer J� Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiier <br /> I•loor drain Retrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined lhis applicalion and know lhe same to be lrue and correcL All provisions of laws and <br /> ordinaces governing lhis lype of work will be complied with whelher specified herein or not.The granting of a permit does not presume <br /> to give authorily lo violale or cancel lhe provision of any olher slale or local law rec�ulating conslruction or the performance of <br /> conslruction.That I am aulhorized by lhe owner o(this property lo periorm lho work for which application is made and I comply with the <br /> Stale Co tors Law 1 °7 RCW and 296200 WAC. <br /> G� � '� � �7 <br /> Signalure o(OwnedCo t clo /A thoriz d Agent Date <br />