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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICE$ <br /> 3200 CEDAR STREET, EVEr�ETT, 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.# PERMI'i# <br /> o v.� /�-v - <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER o ADDRESS CITY/ZIP PHONE <br /> ����rc%�� ��a�Q3 �d�" lOdg ,���� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> RA T R '/� A DRE I Y I E <br /> CONTR.LICENSE q (/ �v � <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleciric Gas_Other <br /> WORK DESCRIPTIUN / <br /> �� �G� �� /I �J� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXI URE OR ITEM <br /> Toilet _ AIC–air handling units <br /> Balhlub _ Forced air syslems <br /> - Lavatory(wash basin) Gas piping <br /> Shower � Water heater <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Water healer _ Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust fan <br /> Backflow pieventer _ Heat pump <br /> Urinal _ Uni�heater <br /> 4 Drinking Fountain _ Boiler <br /> � Floor drain _ Refrigera�ion <br /> Grease trap _ Woodslove <br /> I _ Roof drains _ Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify ihal 1 have read and examined ihis application and know the same to be true and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied with whether spEcified herein or nol. The granting of a permil does not presume <br /> lo give aulhority�o violate or cancel lhe provision of a�y olher state or Iocai law reguiating construction or the performance of <br /> conslruction.That I am authorized by the owner o(tliis property to perform the work(or which application is made and I comply with the <br /> Stale Contraclors law 1627 RCW and 296.200 WAC. <br /> �la�l�� <br /> Signature of OwnedConlreclor/Aulhorized Agent Dale <br />