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PEkMIT APPLICATIOh <br /> CITY OF EVERETT PE''1AIT SERVICES <br /> 3200 CEDAR STREET, EVl :ETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �/ _ 3 —D � <br /> SITE ADDRESS PARCEL TAIC I.D.N PERMIT A <br /> �' • . / 1 !�// ' C�3 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADURESS CITY2IP PHONE <br /> SL�[//�'1 <br /> ANT NAME CONTACT FOR PERMIT PHONE <br /> �` '� - �r 1'w/i `1 � � �/fi-�L'/V �2J �� /�/�/ <br /> CO ACTOR ADDRESS CITY2IP PHONE <br /> CONTR.UCENSE#���y�H�f� y� G�7 <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other (2 �j(� <br /> WORK DESCRIPTION <br /> �jC f-t�r�.d D�iGf"�!/��%- ff'�9DD Dii.'�.is��s <br /> Ut���f �X�r�sTf',Ai✓S <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXNRE OR ITEM <br /> Toilel A/C—air handling units <br /> _ Bathlub � Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kitchen sink 8 disposa� _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Cblhes dryer <br /> Water heater Range hood <br /> Sink(service/badmopletc.) � Exhaustfan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERGTT LOCAL SALES TA7C CODE IS 3105 <br /> i hereby ceritify Iliat I have read and examined Ihis appiicalion and know the same to be true and correct. Ail provisions of laws and <br /> ordinaces governinc�this lype of work will ba complied with whether specified herein or not.The granting oi a permil does not presume <br /> lo give authority to violale or cancel the provision o(any other state or Iocal law regulating conslruction or the performance of <br /> construction.That I am aulhorized by the owner of this propeAy to perform lhe work tor which application is made and I comply with the <br /> State lraclors Law 1 27 RCW and 296.200 WAC. <br /> �/<!!l����� �/ � /Q.�+ <br /> SignaWre o(Own / nlracrodAuthonzed Agent D e <br />