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FrRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CED.AR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM �'j�O S`-�� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> '�� �d� �, �;,� ^ `boT- Oo�� ' s-- �a'c1�-r- C� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER AUDRESS - CITYIZIP PHONE � �. <br /> Jl���iFll/J /�>n� �.S/�. �/.,���� 16,�i� ��,��"�i�/' . J,s.2� <br /> TENANT NAME CONTACT POR PERMIT PHONE <br /> E•MAIL <br /> CO TRACTOR ADDRESS ITY2 PH <br /> CONTR.LICENSE# <br /> U��1'=--� <br /> USE OF BUILDING HEAT SOURCE �CONTRACT PRICE OF VJORK <br /> ��/� �� _Electric _Gas_t7lher W' � LI-(�G�� <br /> WORKDESCRIPTION �� / ���� ��j p��G ���jl �l�e ��+ <br /> .;9�,� �« ,��� �. <br /> . <br /> ,� �� !:z �� � � � .� �� --� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet NC—air handling unils <br /> BaQitub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal _ Gas(ireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Waler healer Ranc�o hood <br /> Sink(service/badmopfetc.) _ Exhausl fan <br /> Backflow preventer Heal pump <br /> Urinal Unit healer <br /> Drinkinc� Founlain _ Boiler <br /> Floor drain Retrigeralion <br /> Grease lrap _ Woodslove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerifify thal I have read and examined this application and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces governing lhis lype of work will be complicd with�vheUier specified herein or not.The granlin�o(a permit does not presume <br /> lo give aulhority lo violale or cancel the provision ol a,y other state or Iocal law regulating conslruction or tho per(ormance o( <br /> conslruction.That I am au �orized by the o�vner o(thi propeity lo per(orm the work for which application is made and I comply�+�ith the <br /> SFet ntractors La�1 7 R and 6.200 <br /> j , � , �, � sn � . <br /> 1 e o Ovmer ontraclor Aulhorized A nt Dale <br /> l(� <br />