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-- <br /> PERMIT APPLICATION <br /> CITY OF EVERETT P2RMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /fJ —/I—/(� <br /> SIT�,ADDRESS„ PARCEL TAX I.D.# PERMIT# <br /> n O �Y� �!P - �z <br /> LEGA L T NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER l ADDRESS CITY2IP PHONE <br /> ��' o '�'lf ��3 e / 6�� �j� Q�f GQ <br /> ENANT NAME CONTACT FOR PERMIT PHONE <br /> / <br /> E•MAIL <br /> rr1 Gh���� ����:i.� �r✓ `���o�/��� �/�� �� 337'�j�/ <br /> CONTR.LICENSE N ' ' / 'l/��J <br /> �Ir.�/ G G 0�?.��.� iii � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �L,�,/' _Eleciric _Gas_Other <br /> L <br /> WORK DESCRIPJJ,qN ; L^� /�l,rl/�� <br /> ��.-i� o.� /1 n�n <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Ctothes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> BacktloH�preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap ._ Woodstove <br /> Roof drains Other <br /> = Other =I <br /> CITY OF EVERETT LOCAL SALES TAx CODE IS�705 <br /> I hereby certify thal I have read and examined lhis appiication and know the same to be true and correct. All provisions of laws and <br /> ordinances governing lhis type of work wili be complied with whelher specified herein or not.The granting of a pertnit does not presume <br /> to give authoritv to violate or cancel ihe provision of any other state or local law regulating conslruction or ihe peAormance of <br /> consiruction.Tha� I am authorized by the owner of ihis properly lo pertorm lhe work forwhich application is made and I comply with the <br /> State Cont�actss Law 18. RCVya d 29 200 WAC. <br /> /�.��'���� /<� �-/,� /C� <br /> Signature of OwnedConlractor/Aulhorized Agent Date <br />