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PE�MIT APPLICATIOtv <br /> ClTY OF EVERETT PER�JIIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ��6 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.ory �p--/ <br /> APPLICATIOIJS ARE ACCEPTE� FROM 8 AM TO 4 PM I <br /> SITE ADDRESS � /� PARCEL TAX L0.# P�j RM� IT# <br /> „ -�l(1 ��!'� �'� �,:1� b��0� �71�5� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> —/-- �� -F^ �'� �( '�- <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# :�i�� ����,�,� �-� �..��� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICt OF WORK <br /> ElecUic Gas Other <br /> WORK DESCRIPTION <br /> � ��� <br /> f <br /> / �L � ��� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Balhtub Forced air systems <br /> LavaWry(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitclien sink&disposal _ Gas firepiace <br /> Dishwasher Glsrange <br /> Clolhes washer _ Clothes dryer <br /> Water heater Range hood <br /> Sink (service;badmop/etc.) _ Exhaust(an <br /> Backflow preventer _ HEaI pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain R2frigeralioi: <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> � Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y lhat I have read and examined lhis application and know the same to be true and correct. All provisions of laws end <br /> ordinaces goveming this type o(work will be complied with�vhelher specified herein or not The granting o(a permit does nol presume <br /> to give aulhoriry to violate or cancel lhe provision of any other state or local law regulating consiruction or the performance of <br /> conslrucliun.That I am authorized by_ll�e-owner-o{-N}is{un�rry to perform Ihe�+�ork(or which application is made and I comply with the <br /> State Contrac rs ' .��WI-aad-2�� <br /> --� ,�"-,d �-C� C' <br /> Signalure of OwnedConlractoriAuthorized Agenl Date <br />