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PERMIT APPLICAl'ION <br /> CITY OF EVERETT PERMIT SERVICES S _09 --o� <br /> 3200 CEDAR STREET, EVEREl'i, WA 98201 _ _ <br /> 425-257-8810— FAY. 425-257-8857—www.everettwa.org <br /> APP!ICATIONS ARE ACCEPTED FROM 8 AM TO 4 PAfl l\ � �', ��� <br /> :;ITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � ����'`�_., � � 1�" l_�.� ,•. i� ',� )<.�� , • �.�_ ;�ci:.� r����� � � ci . <br /> '_EGA LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> / �. i _ ' . . ' _ . .� ' . . i �•! ._\ - . . .. 'T 7 .�..� ��. .. , .i: <br /> C . . � �t <br /> TENANTNAME � ' CONTACTFORPERM�T PHONE <br /> '� � ��I .i--� J •�_ <br /> CONTRACTOR I , , � . '. � ADDFiESS GTYIZIP PHONE <br /> . . . �.. " . i-. ,-�t'i_�;.� � . � !. <br /> - _ ' _ /IL '. .•'Y") r'�_ L <br /> CONTR.LICENSE# '� - � - � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Olher � � <br /> WORK DESCRIPTIOtJ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OFi ITEM NO. TYPE OF FIXTURE OR ITEM <br /> '� Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> 1 Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal _ Gas(ireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> � Water heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaus�fan <br /> _ Backflow preveNer __ Heat pump <br /> Urinal Unit hen�er <br /> Drinking Fountain _ 8oiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Root drains Other _ <br /> Other <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> i ordinaces governing this type of work will be complied with whether specified herein or not.The granting ol a permit does not presume <br /> to give authority ro violate or cancel the provision of any other state or local law regulating consiruction or the pedormance ut <br /> construction.That I am authorized by the owner ot this property to perlorm the work for which application is made and I comply with the <br /> State Con�ractors Law 78.27 RCW and 296.200 WAC. <br /> Signatum o(OwnedCoNractor/Authorized Agent Date <br />