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�- -- - ;- -- <br /> P�RMIT APPLICATION <br /> CIT'( OF EVER�TT PERMIT SERVICES <br /> 3�00 CEDAR STREET, EVERETT, WA 98201 <br /> 425-25�'-8810 — FAX 425-257-8857 —www.everettwa.org <br /> �r � APPLICATIONS ARE ACCEPTED FROM e AM TO 4 PM <br /> � <br /> SI7E ADDRESS PARCEL TAX I.D.# P�RMIT ft <br /> ii ��� �-,� �<�O��J � �o�- c�� � <br /> LEGA LOT NO. BLGCK CT OR SUBDIVISION 11 <br /> DESC. <br /> OWNER ADDRE55 CITYIZIP PHONE <br /> � � 0 /5 Ul tc <br /> TENAN NAME CONTACT FOR PERMIT PHONE,� <br /> �•'�'L. �[� Z Z� '_ �AIL � <br /> RAC ADD I I I E <br /> CONTR.UCENSc ri / „�[�/��� /��� <br /> li(% v <br /> USE OF BUIIDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric Gas Other <br /> WORK DESCRIPTION • <br /> � GL<��C� �� y � I"�C.-,L /� ��l <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> .� Toilet 1 � A/C–air handling unils <br /> � Bathtub �l � Forced air systems <br /> Lavatory(wash basin) � �� � Gas piping <br /> Shower / Waler heater <br /> / Kitchen sinh&disposal � Gas fireptace <br /> � Dishwasher Gas range <br /> � Clothes washer �- Clothes dryer <br /> _ Waler healer � Range hood <br /> Sink(servicelbadmop/elc.) Exhaust fan (�// <br /> Backflow preventer _ Heal pump <br /> Urinal Unil healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerilify thal 1 have read and examined this applicalion and know the same to be irue and correct Atl provisions of laws and <br /> ordinaces goveming lhis lype of�vork will be complied vrith whether specified herein or noL The grenting of a permit does nol presume <br /> to yive aulhorily to violale or cancel the provision of any other slate or local law regulating construction or the peAormance of <br /> conslruction.That I am aulhorized by lhe owner of this properly lo peAorm lhe work for which applicalion is made and I comply with the <br /> Stale Contrectors Law 18.27 RCW and 29G.200 WAC. <br /> /o �3��0$ <br /> Signature of Owner/CcnlraclodAuthorized Agenl Date �/ <br /> 2 <br />