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PERMIT APPLICAI'IUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR 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 � _ a g _�7 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> l% �/5 � _�;r�e.`Jo.� -�Z 7 S <br /> LEGAL LOTNO. �LOCK TRACT <br /> DGSC. <br /> OWNER ADDRESS CINIZIP PHONE <br /> ��Li ��cY�� l(��,vs'rn,.) �9�/ /o7�� 1c� L:vP2 9�� 9�r7y,�'-��'�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CINIZIP PHONE <br /> CONTR.LICENSE# <br /> US�BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � �j�J S����1 _[lectric _Gas_Other <br /> WORK DESCRIPT!ON <br /> � �i.'l��L <br /> �.�1iL0, ��x-( S��F7 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF�IXTURE OR ITEM <br /> Toilel fJC—air handling unds <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower W aler healer <br /> Kilchen sink&disposal Gas(ireplace <br /> Dishv✓asher Gas range <br /> Clothes washer Clolhes dryer <br /> Waler heater Range hood <br /> Sink(service/hadmopletc.) Exhausl(an <br /> Backtiow prevenler Heat pump <br /> Urinal Unil heater <br /> Drinking Founlain Doiler <br /> Floor drain Refric�era!ion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> —I <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined lhis application and know the same to be true and correcL All provisions of laws and <br /> ordinaces poverning this type ot work will be complied wilh whether specified herein or noL The granling of a permit does nol presume <br /> to give a�dhorily to violale or cancel the provision of any other slate or lor,al law regulaling construclion or the per(ormance of <br /> construction. That I am authorized by lhe owner o(this property lo pedorm the work for which application is made and i �omply wilh the <br /> Slate Contraclors La�Jf1827 RCW and 296200 WAC. <br /> `�—�-- ��-:� /o-7 <br /> Signalure of Owner/�ontraclor/Aulhorized A�ent Date <br />