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PtRMIT APPLICATIC�N � <br /> CITY OF EVERETT PERMIT SERVICE, <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 � �r� ,-0� <br /> SITE ADCIRESS PARCEL TAX I.D.# /PERMIT# <br /> %/7��i � � . Ci✓ i�� I��UL� -- � <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADORESS CITYIZIP/�,� PHONE <br /> �' !' �fJ��sr�,J s�,,� �v�er�7- �al 4�.J-=iSl-� <br /> TENANT NAME CO�TACT FOR PERMIT PHONE <br /> J � E•MAIL <br /> CONTRACTOR . r ,i] ADDR[SS CITYIZIP PHONE <br /> �V f-f <br /> CONTR.LIC[NSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 'F,��� ���0���� _Eleclric �Gas_Olher �/� �"" � <br /> WORK DESCRIPTION �+� � �f�i LI� <br /> �i�vis.� ��'��e2co2 mN'cy o� ����,� � -�,�— � <br /> fi�-24Ge � d t,cce/'` r✓l,� ���.�,/'� xs���-l- Z"`{ �tia��;� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling unils <br /> Balhtub � Forced air systems �kYs i'(� I <br /> _ Lavalory(wash basin) Gas piping <br /> Slio�ver Water heater <br /> Kitchen sink&disposal Gas(ireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> ',Naler healer Range hood <br /> ( �_ S�k(service/bar/mop/etc.) _ Fxhaust fan <br /> ' B.�cktlow preventer Heal pump <br /> Urinal Unit heat�r <br /> Drinking Founlain Boiler <br /> Floor drain Refrigerelion <br /> Grease lrap Woodstove <br /> Root drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined lhis application and hnow the saine to be true and correcL All provisions of la�vs and <br /> ordinaces governing Ihis lype of work�t�ill be complied�vith whether specified herein or noL The granling o(a permil does nol presume <br /> to give aulhority to viulale or cancel the provision of any otiier state or local la�v reyulating consiruction or the performance of <br /> construclion. Tha� I am authorized by the owner of lhis propertv to perform the work for which application is made and I comply wi�h lhe I <br /> Slale Conlrac¢ors La 1627 RCW and 296.200 WAC. I <br /> `'( �- �'-al-�'' <br /> Signature of O�vn� ConlraclorlAulhorized Agenl Dale � <br /> � -- `� <br />