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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 987_01 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCFPTED FROM 8 AM TO 4 PM g �pJ_J°� <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> � i � S' �,��� ��, '' b� ' �'�7 <br /> LcGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER AO�RESS CITY2IP PHONE <br /> ��'i� ��c�., ��G (�ok � Z (��z �'v«�c �i�2�L 5'> s �az 2 j� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �� E-MAIL <br /> CONTRACT R DDRESS I IZP PHONE <br /> CONTR.LICENSE# �)-, �..n 11 <br /> !-J T � ` <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � I� _Electric _Gas_Other —`� .�D-0 <br /> L <br /> WORK DESCRIPTION <br /> . <br /> C� �� c��r.r-'-���� !;C j�,< < t �� �v'� ca�,•`C <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FU(TURE OR ITEPA <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) . _ Gas piping <br /> Shower Waler hea�er <br /> Kitchen sink 8 disposal _ Gas firepiace <br /> Dishwasher Gas range <br /> Ciolhes washer Clothes dryer <br /> Waler healer —� Range hood <br /> Sink(service/badmoplelc.) � Exhaust(an <br /> BackOow prevenfer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodslove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhal I have read and examined this application and know lhe same to be lrue and correct. All provisions of laws and <br /> ordinaces governing this lype of work will be complied wilh whelher speci(ied herein or noL The granling ot a permil does not presume <br /> to give authority to violale or cancel lhe provision o(any olher state or local law regulating construction or the performance of <br /> con;truclion.Tfi t I am authori ed by lh�e ��erof t us properly lo perform the work for which application is made and I comply with the <br /> Slale ConiraEto Law 18.27 CW-.n�-296.200 WAC. <br /> �. <br /> ' .�.� , ��.L c,C:> > �� � � c� � <br /> Sic�nature f OwnedConlractor/Authonzed Agent Date <br />