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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810– FAX 425-257-8857 –v�ww.everettwa.org <br /> �� �— APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL iAX I.D.# PERMITpi <br /> i� ia� �� ���%� � �v� or� � <br /> , <br /> LEGA LOl N0. BLOCK CT OR SUBUIVISION IJ <br /> UESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �D � UI � <br /> TENAN NAME CONTACT FOR PERMIT PHONE �', <br /> J <br /> D/�'L.- �� ZZ� E�AIL� <br /> ONTRA R A DR�SS q / P E <br /> CONTR.LICENSE# / �,�(,/y�J " '_` �LZI�(A - <br /> liV J � '"� <br /> USE OF BUILDING HEAT SOURCF � CONTRACT PRICE OF WORK <br /> _Geclric _Gas_Other I <br /> WORK DESCRIPTION • <br /> � Q-��C.� �� y ` (-�/G"�-- /��y' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C–air handlin�uniis <br /> � �athWb �/ � Forced air systems <br /> Lava�ory(wash basin) � �� Gas piping <br /> Shower Water healer <br /> —T Kilchen sink&disposal � Gas(ireplace <br /> � Dishwasher Gasrange <br /> � Clolhes washer � Clothes dryer <br /> Waler heater Range hood <br /> Sink (service/badmop/elcJ � Exhausl fan f�/� <br /> Dach(low preventer _ Heat pump <br /> Urinal _ Unil healer <br /> Drinking Fomdain _ Boiler <br /> Roor drain _ Re(rigeralion <br /> Grease trap _ Woodstove <br /> Roo(drains _ Other <br /> Other _ — <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y that I have read and examined lhis application and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces governing this typc of work will be comp�ied with whelher speci(ied herein or nol The granling of a permit does�iol presume <br /> lo give aulhority lo violate or cancel the provision of any olher state or Iocal law reguleting construction or the periormance of <br /> construclion.Thal I am aulhorized by the owner of ihis property to perform the work for which application is made and I comply wilh the <br /> Slate Contraclors Law 18.27 RCW and 296.200 WAC. <br /> ��3/�D �' <br /> Signature o(OwnedContractor/Aulhorized Agenl Date i / <br /> IZ <br />