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PERMIT APPLICATIC�N <br /> CITY 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 3 , S� g <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � � - V.. _ l��-� �j - �0' <br /> `CEGAL LOT NO.� BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �>y, � �-� Jv�--�-z--- ��vi ��3� <br /> , <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �,�� C Jtt+'1�1i'3� � E-MAIL <br /> CONTRACTOR ADD ES ITY/ZIP P O E <br /> CONTR.LICENSE# � � <br /> /� .i l•,f :_�--�� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric Gas Other <br /> WORK DESCRIPTION <br /> � , , <br /> ����-U "� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sirk&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Cbthes dryer <br /> Waler heater Rango hood <br /> Sink(servicelbar/mop/elcJ Exhaust fan <br /> Backllow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeralion <br /> Grease trap Woodstove <br /> Roo(drains Olher <br /> Other <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 goveming Ihis rype ot work will�e complied with whether speciBed herein or noL The granling o(a permit does not presume <br /> to c�ive aulhority to violale or cancel the provision of any olher state or local law reg�dating construction or the performance oi <br /> conslruclion. That I am aulhorized by lhe owner o(lhis property to per(orm the work for which application is made and I comply wilh the <br /> Slate Conlraclors Law if1.27 RCW and '296.200 WAC. <br /> -�' .-t-�� � 5 c� <br /> Sic�nature of OWner/ConlraclodAuthorized Agent Date <br />