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FcRMIT APPLICATIvN <br /> CI�TY 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 /> SIT[ADDRESS Q S PARCEL TAX I.D.# ERMIT# <br /> /3�� � �DSSia-�5 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> S��-�.. /��,o �.�.. �as- ; �� �ysy <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> E•MPJL <br /> NTRACT R AD E � <br /> CONTR.LICENSE# <br /> ;�o� C���-� � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �/ !"� _Electric _Gas_Other <br /> WORK DESCRIPTION <br /> �,r�/a � �� G� �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR I7EM <br /> Toilel A/C—air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitclien sink& disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/badmop/elc.) Exhausl(an <br /> Backflow preventer _ Heat pump <br /> Urinal Unil healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodstove <br /> � Roof drain l / ` /� �— _ Olher <br /> � ou,e� G,�—�/� G� — . <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> I hereby ceriti(y thal I have read and examined this applicalion and know the same to be lrue and correcL All provisions of laws and <br /> ordinaces goveminc� this rype of work will be complied�vith whether specified herein or noL The granting of a permit does not presume <br /> to give aulhority to violale or cancel lhe provision ol any other slale or local law regu�aling construclion or lhe performance of <br /> conslruclion. Thal I am aulhorized by lhe owner of Ihis properly to pedorm ihe work for which application is made and I comply with the <br /> Slate Conlraclors Law 18.27 RCW and 296.200 WAC. � <br /> � 1 �'`l�Y`�� �c�—� "7� <br /> Signature w �dConlractor/Aulhorizecf Ac�ent Dale <br /> I <br />