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f <br /> � -. <br /> � PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICE� <br /> 3200 CEDAH STREET, EVERETT, WA 98201 <br /> 425-257•8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FHOM 8 AM TO 4 PM <br /> I SITE ADORESS PARCEL TAX I.D.# PE MIT i l I <br /> l3os��O�� oo�iso�y9Qoao� /;,� �cC� - '�; � <br /> LEGAL LOTNO. �B�OCK _ T�TO��SU�DI�IONq <br /> DESC, 3 L � T I <br /> OWNER ADDRESS CI IP PMONE <br /> ,�'-a� �3��C��c � C��-95''�� �� I <br /> TENANT NAME I CONTACT FOR PERMIT PHONE I <br /> &MAIL � <br /> �//S �l/5"f�'� 9'S'id� �< 9G��9�' <br /> CONTfl.LICENSE p�/�G ,! �G /�/p�� � ��' � ;7 <br /> � /r /� �l <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���/t;�l--� _Electric �Gas_Other � �7�f��/ .� <br /> � �1 <br /> WORK DESCRIPTIO � '����� �'✓`,',���/�� <br /> rfv� � �/ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air syslems <br /> _ Lavatory(�vesh basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher � Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Ranc�e hood <br /> _ Sink (service/badmop/eic.) _ Ezhaust lan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinkinc� Fountain _ Boiler <br /> Floor drain Relrigeration <br /> Gmase trap Woodstove <br /> Roof drains O�her <br /> -- Other------ <br /> I i <br /> ICITY OF EVERETT LOCAL SALES TAX CODE IS 3105 I <br /> I hereby ceritily that I have read and examined this application and know the same to be uue and correcL All provisions ol laws and <br /> ordinaces goveming this type ol work will be complied with whether specilied herein or not.The graneing of a permit does not presume <br /> I io give authoriry to violate or cancel the provision ot any other state or local law regulating consiruction or Ihe performance oi <br /> construction.That I am aulhorized 6y ihe ovmer ol this propeny to pedorm�he work for which application is made and I comply with ihe <br /> State CoM�lciors Law 1�7�n�.200 WAC. <br /> /�� �y�,,,� <br /> i.- /�/ i �t/ <br /> SignaWre ol OwnedConlractor/Authorized Agent Date <br />