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�ERMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT N <br /> 0 �i � ST � U DO Bo�oS• ocSFl <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> U I�O L� i�! V f7 ���- /5U� "�INE s7 �v��'t%r i���25'���5d-5,37 <br /> 7ENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE M <br /> USE OF BUILUING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas_Other <br /> WORK DESCRIPTION <br /> �I�UL i -��91'�l�c `/ �/�o�"t <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FU(TURE OR ITEM <br /> Toilel _ AIC—air handling units <br /> Bathtub _ Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Water healer <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Clolhes dryer <br /> Water heater _ Range hood <br /> Sink(service/barlmop/etc.) _ Exhaustfan <br /> 5ackflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Retrigeralion <br /> Grease Irap _ woodstove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritify lhat I have read and eramined lhis applicalion and know the same to be true and correct. All provisians oi laws and <br /> ordinace:,�overning this lype of work will be complied with whelher specified herein or nol.The granting of a permit doas not presume <br /> to give a�thor.ty to violate or cancel the provision of any other stale or local law regulating construcUon or lhe peAormance of <br /> construclion That I am aulhorized by lhe owner of this properry lo peAorm lhe work for which applicaLon is made and I comply wilh lhe <br /> Stale C�ontractors Law 18.27 RCW and 296.200 WAC. /� <br /> ������C r.�CG-C.L. `i. .;'/D-' O(C <br /> Signature o!Owner/CoNrecto�lAuthorized Agent Oate <br /> I <br />