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'�, P�RMIT APPLl�;ATIOf� <br /> CITY OF EVERETT FERMIT SERV(CES <br /> I 3200 CEDAR STREET. EVEPETT. WA 98201 <br /> 425-257-8810 - FAX 425-p57-8857 - www.everet�wa.org i <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � `�'�"�� I <br /> SITE ADDRESS PARCEL TA% I.D.# P�RM�� /,/ � � <br /> � � <br /> LEGAL LOT NO. BLOCK TRACT OR SUB�IVISION N �. <br /> � DESC. ' . '. � '� �.i. .. _ - .. � . <br /> OWNER ADDFiESS� CITY.41P PHONE ,, <br /> . � .. . . .,., . . . . . , ��,.. - . .' ' - � _' ' " � '-�!,. . <br /> TENANTNAME CONTACTFORPERMIT PHONE . , . - � - - - ,. �� <br /> EMAIL �. : - ` � `...� <br /> i C NTRACTOR ADDHESS TY/ZIP PHONE li <br /> I�I CONTR.UCENSE# ' �I <br /> I USE OF BUILDING I — HEAT SOURCE I CONTRACT PFiICE OF WORK � <br /> Eleclric Gas_Other <br /> � WORK DESCRIPTION �' <br /> '� . . r . . . - . . . _ . . � � - �, <br /> <' li <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FIJ(TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> �IToi�ei _ A�C-air handiing units � <br /> � Balhwb Forced air systems �� <br /> L�vatory(wash basin) _ Gas piping I. <br /> I Shower Water heater � <br /> hitchen sink&disposal _ Gas lireplace <br /> I Dishwasher __ Gas range , <br /> �. Clothes�vasher _ Clothes dryer �, <br /> � Water heater _ Range hood i <br /> � Sink (service�barlmop'etc.) _ Ezhaust fan , <br /> � Backflow preventer ___ Heat pump I <br /> Urinal Unil heater I <br /> Drinking Fountain Boiler � <br /> Floordram _ Refrigeration �I <br /> Grease trap _ Woodslove I <br /> � . � Rool drains ___ Olher _ <br /> . Olher -- — I <br /> � CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 I�I <br /> I hereby cerilify ihal I have read and ezamined lhis appl�cation and know Ihe same ro be true and correct. All provisions of laws and �il <br /> � oruinar,es goveming�his type ot work will be complied with whelher specilied herein or not. The granting of a permit does not presume , <br /> to give authority to violate or cancel�he provision of any other state or local law regulaling construclion or ihe performance ol <br /> consiruction. That I am aulhorized by Ihe owner of Ihis property to pertorm the work for which application is made and I comply wilh�ha I <br /> '� State Contraclors Law 18.27 RCW and 296200 WAC. <br /> .v 21 �0� II <br /> � ilgnawre of OwneriCoMraclodAuthorized Agent Date <br /> � --- - - - - �- -- - � -------�-- -- ---- �------� <br />