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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAY.425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> SG f VERFT i �IAU, vvR �-�/ <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITV2IP PHONE <br /> M�� K � sT�o �-� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> °���-L woo,t� �v�N�Tw2� T�vl J�T� R N�-S - S I 3 - ��-�� / <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> COHTR.LICENSE+1 `���J r����� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ElecMc Gas Other <br /> WORK DESCRIPTION <br /> !�JSjALL �SI �� ;. � �t���KS ��' �T;-� ST� UC i��l?fl L AJ(�t�5► �� <br /> PLUMBING MECHAiVICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas�iping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Cbthes washer Clolhes dryer <br /> Laundry lray Range hood <br /> Sink(service/bar/mop/etc.) Exhausl fan <br /> BackFlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain _ Refigeration <br /> Grease trap Woaistove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I liereby ceritify that 1 have read and examined this applicalion and know the same to be irue and corted. All provisions of laws a:•d <br /> ordinaces goveming this lype of vrork will be complied with whefher specfied herein or not.The granting of a pertnit does�ol prcsume <br /> to give authority lo violate or cancel the provision of any other state or local law regulating construction or Ihe pertormance oi <br /> construction.That I am authorized by lhe owner of lhis property to perform the work for which application is made and i comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> Signature ef OwnedContractor/Authorized Agent Date <br />