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� ��RMlT APPLICATII,N 1 <br /> C11�Y OF EVERETT PERMIT SERd��ES <br /> 3200 CEDAR STREEI', EVERETT, WA 98201 �.�US— _ <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> i <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARGS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# F P/ERMI7# <br /> . ' � ,, i ' � i-,.:'� ��/,' /"\%� % (� Q�?'._.�1..,' I_�.� . - � <br /> LEGAI LOTNO. BLOCK TRACT - <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP_ PHONE <br /> / ' � !�C'r�� <br /> . . . ._ �� :i / � � � , _� `/ �`�: /%i 'J �" �'v� � l� 'i`,�f ��" � �i-'� ��' 1v . <br /> TENANT NANiE �� CONTACT FOR PERMIT PHONE <br /> - � ' i-�' � , - i' � f ��, � r� _ � _;�;.:; � <br /> ; <br /> CONTRACTOR ��� AD�RESS CITY2IP PHONE <br /> � , �, �, ,t,'/ �'�'� ` : ; ,�" / Y' �F . ' � i - , _`� - ��%� +, <br /> CONTR.�L:CENSE# _ . <br /> � : , r�;'`j �� J J /_= �:� ;.r � <br /> USE OF BUILDING .,���'`� �� I HEAT SOURCE CONTRACT PRICE OF WORK <br /> . . . ;' �_����'Eleclric _Gas_Other <br /> WORK DESCRIP7?•7N - �' <br /> � <br /> - / � ^.n�� ! ) � �1� �:�` . _ <br /> / , i., . � . _, f <br /> FLUfvIBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIX7URE OR ITEM <br /> Toilet A/C-air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower W ater healer <br /> Kitch2n sink 8 di�,��;�t Gas fireplace <br /> Dishwasher Gos rengc <br /> Clolhes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/badmopietc.) Exhausl(an <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> _ Floor�'rain Refriperalion <br /> Grease trap Woodslove <br /> Roof drar�� Olher <br /> � Olher <br /> CITY OF EVERETT LOCAL SALE;i TAX CODE IS 3105 <br /> I hereby cerili(y lhat I have read ar.d ezamined lhis applicnlion and know the same lo be Uue and corract. Ali provisions of laws and <br /> urdinaces goveming this type of work will be complied wilh whether specified herein or not.The grantir,g of a permit does not presume <br /> to yive aulhonty to violate or cancel lhe provision of any other state or focal law regulating construction or the perfo�mance of <br /> conslruction.Thal I am authorized by the owner o(this property to perform the work for which application is m2de and I comply with the <br /> Stale Conlractors Law 1827 RCW and 2P6200 WAC. <br /> . . . � .. ' � - �/�/� . <br /> SignaWre of OwnedContractor/Authorized Agent Date <br /> L- - <br />