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wERMIT APPLICATIt�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEOAR 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 ADDFESS PARCEL TAX I.D.# PERMIT# <br /> � (�i� O �!5 �� 35' Z33 , Gl 7u=� OcuoS -a�/ <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> P�� �� r �..��� ����;' �n'�P��r« � r�,�r�.,,,,,r ��` &���-�r4� <br /> TENANT NAME � CONTACT FOR PERMIT PHONE <br /> ��JL�!-� G,mf�S <br /> CONTRACTOR A�DRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> 6 ��n-°�� <br /> USE OF BUILDING HEAT SOURCE ( CONTRACT PRICE OF WORK <br /> �,�y�'� 7 � _Electric _Gas_Other _ <br /> WORK DESCRIPTION <br /> �EM'�� 1, S h G u,-r.� t' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet NC—air handling unils <br /> Bathlub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Cblhes washer Clolhes dryer <br /> Walen c�aler Range hood <br /> Sink(service/bar/mop/etc.) _ Exha�st fan <br /> Back(low prevenler _ Heat pump <br /> Urinal Unil healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Uther <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> I hereby ceriti(y that I have read and examined this application and know tho same to be l�ue and correcl. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whelher specified herein or not.The granling of a permit does nol presume <br /> to give autheriry lo v'ol� e or nce �e provision oi any other state or local law regulating construclion or the pedormance of <br /> construction.Thal I uU ri e y ie owner o(lhis property to pertorm the work for which application is made and I comply with the <br /> Stale Conlraclors L 2 R and 96.200 WAC. <br /> SignaWre o(OwnedContractodAulhorized Agenl �Dale( �� I <br /> I <br />