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PERMIT APPLICATIVN <br /> r,ITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ARDRESS PARCEL TAX I.D.# I PERMIT# <br /> ��S ►3 �P� n� .�� � i r�a�-rs i <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> _�,��i mr�e,� � ��r� I�i ► - �� � �� o � <br /> TENANTNAME I CONTACTFORPERMIT �HONE <br /> \J <br /> CONTRACTOR ADDRESS C� ,YIZIP PHONE <br /> CONTR.LICENSE# OG✓ �(j� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric �Gas Othor <br /> WORK DESCRIPTION <br /> / 7 —l��v,i !'�� /� <br /> -�v` S�� �2'`-� �) ' � C� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—air handlinc� unils <br /> _ Balhtub Forced air syslems <br /> _ Lavatory(wash basin) Gas piping <br /> _ Shower Water heater <br /> _ Kitchen sink&disposal � Gas fireplace <br /> _ Dishwasher Gasrange <br /> _ Clothes�t•asher Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/badmop/elc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> _ Urinai Unil heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Olher <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions oF laws and <br /> ordinaces governing tliis lype of work will be complied with whelher specified herein or nol.The granting of a permit does not presume <br /> lo give aulhority to violate or cancel the provision of any olher slate or local law rec�ulating construclion or the performance of <br /> conslmction.Thal I am authorized by t owner of ihis property lo peAorm lhe work for which application is made and I compiy with the <br /> Slale Cqnlrac ors Law 18.27 R W and 2 6.200 WAC. <br /> ' -;; li�z� �a��s <br /> Sig tUre o(Ownerl� tract uthonzed Agent Date <br />