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PERMIT APPLICATION <br /> CIl'Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR S�REET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTEO FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT# <br /> '71? E L I�'1 S'f- �� U �Gb 2(70 '1�.� I,�l 0('� <br /> LEGA LOT NO. BIOCK TRACT OR SUBDINSION/ <br /> DESC. TI12J a.�u -TJoc�t FauS� Ps��z� n�� �iu F� ��.tic,- �r p�J A <br /> OW�IER AODRESS CITY/LP PHONE <br /> �Ac.�t CA�� s�.?�-7 E�rh E✓�.---;r 9�Zo3 Z5B S35 <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> S P M� E�u� <br /> CONTR.LICENSE i <br /> USE OF BU�LDING HEAT SOURCE CONTRACi PRICE OF WORK <br /> �j- 1 rJ LL ��a��'1 I L� _ElecMc �Gas_Other �1z Uvv•i7 v <br /> WORK DESCRIPTION r i1,::�;� �� ' _ =�'(��l �� �i� -�`'� !� i � �;= . <br /> (•' �. ` ' , �i Lt i �-� 0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel AIC—air handling units <br /> Bathlub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishvrasher Gas range <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/barlmopletc.) Exhaust fan <br /> Backtiow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain 8oiier <br /> Fioor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> I hereby certify thal I have read and examined this app�icalion and know lhe same to be true and�rrect. All provisions of laws and <br /> ordinances governing this type of work will be complied with whelher specified herein or not. The granting of a permit dces not presume <br /> to give authonty to violate or cancel the provision of any other state or loral law regulatlng consWction or the performance of <br /> conslruction. Thal I am aulhorized by lhe owner o(lhis property to periortn the vrork for which applicatlon is made and I comply with the <br /> Stale Coniradors Law 1827 RCW and 296.200 WAC. ` <br /> C/ <br /> Signature el'OwnerlContractodAuthonzed Agent Date <br /> --�, i _ ��� <br /> �;� .� '����_, <br />