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� <br /> p�RMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 g—�g—O(� <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTEU FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � `� �(�}'"�� �'iG�tAP�—C�S—I <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER p�� ADDRESS CITYIZIP PHONE <br /> V A�V� (�� 1�..'�r V `� l..lJ�-/A <br /> TENANT NANr CONTACT FOR PERMIT PHONE <br /> CONTRACTOR /"�_ _ ,�, L I�-I ���,?�DRESS � CITY2IP PHONE <br /> �SiJ\.� 1 I�1 �-k ;;4 <br /> CONTR.LICENSE# l/ <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> �1,� �a 2�D�� <br /> PLUMBING MEi�HANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> BathWb Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink& disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clo!hes washer Clolhes dryer <br /> Waler healer Range hood <br /> '� Sink(service/badmopletc.) Exhaust fan <br /> � _ Backflow preventer _ Heat pump <br /> Urinal Unil healer <br /> Drinkin� Founlain Boiler <br /> Floor drain Refrigeralion <br /> ; Grease lrap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceriLfy Ihal I have read and examined this application and know the same to be true and correcL All provisions of laws and <br /> ordinaces goveming lhis lype o(work will be complied wilh whether specified herein or noL The granling of a permit does nol presume <br /> to give aulhorily to violale or cancel the provision o(any other slale or local law rec�ulating consWclion or the per(ormance of <br /> conslruclion.Thal I am authorized by the owner of this properiy lo perform the work for which applicalion is made and I comply wilh lhe <br /> Stale Contraclors Law 18.27 RCW and 296.200 WAC. <br /> Signalure of OwnedContraclodAuthorized Agenl Date <br />