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PEKMIT APPLICATION <br /> CITY OF EVERETT PERM�T SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM a.. - ( �--Q� <br /> S�Te ADDRESS PARCEL TAl( I.D.# PERMIT# <br /> ���I� C.•.l 'r<<,S J7. �f�-.L�� Mol[ , Z-r'z <br /> LEGAL LOT O. BLOCK TRACT <br /> DESC. <br /> �O� W) NER ADDRESS CITYIZIP PHONE <br /> �"c, -�-V,% k- ����IN� �S15 �,1,��;5 S�, 981�3 t.�-3� � 7s2� <br /> TENANT NAME CONTACT FOR PERMIr PHONE <br /> � I �� rJc,+v�lk ���JF � 1�" ��� 75�b <br /> CONTRACTOR ADDRESS CITY/21P PHONE <br /> CONTR.LICENSE# ���� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Olher <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE Of FIXTURE OR ITEM <br /> Toilet NC—air handling units <br /> Balhlub Forced air systems <br /> _ Lavalory(wash b�sin) Y' Gas pipinc� <br /> Shower � Waterhealer <br /> Kilchen sink 8 disposal _ Gas freplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler healer Ranc�e hood <br /> Sink(service/badmop/etc.) _ Exhaust fan <br /> BackOow prevenler Heat pump <br /> Urinal � Unil heater <br /> Drinking Founlain _ Boiier <br /> Floor drain Refrigeralion <br /> Grease Uap _ Woodslove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify lhat I have read and examined lhis applicalion and know lhe same to be true and correcL AII provisions of laws and <br /> ordinaces c�oveming lhis lype of work will be complied wilh whelher specified herein or not.The granting of a permil does not presume <br /> lo give authoriry to violale or cancei the provision of any other stale or local law regulating conslraclion or the peAormance of <br /> construction.That I am aylh rized by lhe owner of Ihis property lo per(orm ihe work for which application is made and I comply wilh lhe <br /> Stale Contraclors Law P. �:C and 296.200 WAC. <br /> �-%' / Z� ��,,�- <br /> Signature o�OwnedCon rt or Authonzed Agent Dale <br />