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PERMIT AP�LICATI�N <br /> CITY OF EVERETT PERMIT SERNICES <br /> 3200 CEDAR STREET, EVERETT. WA 982G�1 <br /> 425-257-8810— FAX 425-257-8857—www.everettrva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.A PERMIT�I �p� <br /> Zzr� (y�wn� f{Ve . 7/ �`r-o <br /> LEGA LOT NO. BLOCK TRACT OR SUBDMSION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHON <br /> S- 33v-6�� <br /> � ��J�y, s s wr� /-��1(0 �� �� Gr��l /�(y�e ��lY, �I�aD� <br /> 7ENANf NAME I CONTACT FOR PERMIT PNONE <br /> E�MAIL <br /> �� <br /> CONTR.LICENSE N ���U�L <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> '-""�����`� 1C Electric Gas Olher <br /> WORK DESCRIPTION �S�,Q����� �i/�/��a(� <br /> `., <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling units <br /> Bathtub Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Shower ^ Water heater <br /> Kitchen sink 6 disposal � Gas flreplace <br /> Dishwasher Gasrange <br /> Cblhes washer Clothes Aryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Rooi drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat I have read and examined this appiicalion and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces governing this type o(work will be complied wiln whe�her specified herein or not.The granling of a pertnit does not presume <br /> lo give authority lo violale or cancei lhe provision of any olher slale or local law regulating wnstruction or lhe periormance of <br /> construction.That I am authorized by the owner of lhis property to perform the work for which application is made and I comply with lhe <br /> State Contraclors Law 18.27 RCW and 296.200 WAC. <br /> , � _---. !Z Z�F O <br /> Signature o w r Conlraclor/Aulhorized Agenl Date <br />