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� PERMIT APPLICATION <br /> CITY OF EVERETT FERIV�IT SERVICES <br /> 3200 CEDF.R 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� <br /> SITE ADDRE°S� 7 PARCEL TAX I.D.# PERMIT# / <br /> L �� ���C�I�(�fI 1��UCII l.'�l ' � '_/� �— �� <br /> ;( <br /> LEGAL LUTNO. BLOCK RACT <br /> DESC. <br /> OWNER ADDHE55 CIN/ZIP PHONE <br /> Prz�l�. �{ ;�i�i�;����; �����.. ;r�� ti�, -r��,r��-i .�; �"'1��; l�� ti��:� =?� '���5 <br /> TENANTNAN�E CONTACTFOR ERMIT � i5F] ,�,��Jei� PHONE .JC�lJ�ZU-O�' XIJ <br /> ` �� � � ' � ��G.)"i�,�J � <br /> .atir�� �� ��. r�f r�c�z �����t L` ����f������� oyS <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> G'�1,� � ��� �'!�i c'�cic�t'iL�t.f ��i�c' S, _��-Lt�f1� �'.!� (����)FZG -C7tc� <br /> CO T�.L CENSE# - <br /> ��! �� w_,___����� �.i�q' �"'1 `�l�i l z 4`c'[- �I�I C�� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> t������ _Elecinc �as_Other ��j �,�i <br /> 1 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. NPE OF FI%TURE OR ITEM <br /> Toitet A/C—air handling units <br /> Balh�ub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Sh�wer Water heater <br /> Kilchen sink&disposal Gas 5replace <br /> Dishwasher Gas renge <br /> Clothes washer Clothes dryer <br /> Laundry tray _ R�nge hood <br /> S�nk(servicelbar/mop/etc.) Exhaust fan <br /> Backflow prevenler Heat pump <br /> Urinal Unit healer <br /> Urinking Fountain _ Boiler <br /> Ploor drain - � Refnge2lion - <br /> Grease trap Woodstove <br /> Roo(dreins Olher <br /> Olher <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> I hereby ceritify that I have read and examined lhis application and know the same lo be true and correct. All provisions of laws and <br /> ordinaces govemiig this type of work vnll be wmplied with whether specifed herein or not The granting of a pertnit does not presume <br /> to give aulhority to violate o:cancel the provision of any other stale or local law regulating construction or the performance of <br /> construclion.That I am authorized by lhe owner of this property to perform lhe wor!<for which applicalion is made and I comply with the <br /> Stat=C ntractors Law 18.27 RCW and 296.200 WAC. <br /> �� J <br /> -�� �/�_i��c��'-7 �� 'I:�_���� <br /> ,,Si naWre of OwnedCnntractor/Authonzed Agent Date <br /> / � <br /> � <br />