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P�RMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.�rg <br /> � - �i-o°I <br /> APPLICATIONS ARE ACCEPTEU FROM 8 AM TO 4 PM <br /> SITE{�DDRESS�� PARCEL TAX I.D.# PERM�T p <br /> � �O /�-Q.��C'1�A� 1`, C�c 1 �i '. � �l..t: <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> l���o�.ti �.� u,aN�� �ao� ��;�:s���a� y�s���r �as 3-���S <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> E•MAIL <br /> CONTRACTOR ADDRE S —�YIZI— P PHbNF <br /> % <br /> CONTR.LICENSE# / ��� <br /> l. <br /> USE OF BUILUING I HEAT SOURCE CONTRACT PRICE OF WOR'.< <br /> �� �`_ _Eleclric _�as_Other <br /> WORK DESCRIPTION <br /> �s�-'.�I �-'�� �j� /bz ,��� �Gtti.,f�5 �i"J � �'l.�ilitkC.�� <br /> PLU�.IBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet fVC—air handling units <br /> Balhtub = Forced air systems <br /> _ Lavalory(wash basin) � Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> _ Clothes washer Clolhes dryer I <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) Exhausl fan <br /> Backllow preventer Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeralion <br /> Grease Irap Woodslove <br /> Roof drains Other <br /> Olher <br /> ' <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examir�ed lhis applicalion and know lhe same to be true and correcL All provisions o(laws and <br /> ordinaces goveming Ui�s lype of work will be complied�vith whether speci(ied herein or noL The granting of a permit does nol presume <br /> lo give authoriry to violale or cance�lhe provision of any olher slale or local law regulaling consWclion or the performan�e of <br /> construclion.That I am authorized by the owner of this property to perform the worh for which application is made and I comply wilh the <br /> State Coi' t rs�I.ay�' 18.27 RC�96.200 WAC. I <br /> /'�L'�/ <br /> Signat e of O�vnedConlractor/Authorized P,genl Date <br />