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, . <br /> PERMIT APPLICATION <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 <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT A <br /> �� e <br /> LEGAL LOT N0. BLOCK 7RACT OR SUBDIVISION K <br /> DESC. <br /> OWNER (� ADDRESS CITY2IP PHONE <br /> � � \\v . `L�\e-S � <br /> 7EN TNAME('''�, CONTACTFORPERMIT PHONE �� � ll <br /> 1vVIr.�YI\C�� " 'yS��1��""V'1 I /�1�CC�'� \`�O��W�6w\ E�MAIL <br /> �bATFFAL`�S� � ` � <br /> CONTR.LICENSE# /�\ .._ E�i� �ll U� �'JM`1 G r � ¢LS 3¢% �D�T <br /> LJ�✓V\ � Y <br /> USE OF SUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I _Eieclric �Gas_Other � <br /> WORK DESCRIPTION'� - � <br /> ��v�� � �� J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIX7URE OR ITEM <br /> Toilel __ A/C—airhandlingunits <br /> Bathtub _ Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas Tireplace <br /> Dishwasher Gas range <br /> Clothes washer _ Clolhes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust tan <br /> Backflow preventer _ Heat pump <br /> Urinal Unil heater <br /> Drinking Founlain 8oiler <br /> Floor drain _ Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this application and know the same to be lrue and cortect. All provisions ot laws and <br /> ordinaces governing this rype of work will be complied with whether specified herein or not.The granling of a permit does not presume <br /> lo give authoriry lo violate cc�ncel the provision of any other state or Iocal law regulating construction or the performance ot <br /> construction.T al-I m author¢ed ny lhe owner of this property to periorm lhe work tor which applicalion is made and I comply with the <br /> State Co9tr ctors Law 18.2�R�and 296 Z00 WAC. <br /> - <- -��,%� � �g"�Ug <br /> �� �SignaWre o(CwnedContraclor/Au onzed Agent ' Date <br />