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PEhtMIT APPLICATION <br /> CITY OF EV�RETT 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 �J „/�/`O� <br /> SITE ADDRESS PARCEL TAX I.D. # QERMIT# <br /> � '� ��U - � � ( <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRE55 C�TYIZIP PFIONE <br /> � � Y'7�n 5 P I� �[7i CVf(� 1�}- / <br /> TENANT N E CONTACT FOR PERMIT PHONE <br /> ��S S�� <br /> ' E-MAIL /.3 S� <br /> CONTRACT R ADURESS CITYlZIP PHON <br /> CONTR.LICENSE p <br /> (1� 1t�:r- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���, '. ��n� ; 1 _Eleclric _Gas_Olher <br /> WORK DESCRIPTION <br /> 1 -� ��i�' �� <br /> I PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ' Toilel A/C—air handling unils <br /> Balhtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower W aler heater <br /> Kitchen sink&disposal Gas(ireplace <br /> Dishu�asher . Gas rangc <br /> Clothr.s washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/badmop/elc.) Exhaust fan <br /> Back(low prevenler Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeration <br /> Grease trap Woodslove <br /> Roo!drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby ceriti(y lhal I have reaJ and examined lhis application and know the same lo be lrue and correcl AI�provisions of laws and <br /> ordinaces governing this type of work will b�complied wilh whether specitied herein or nol.The granting of a permit does nol presume <br /> to give aulhority to violate or cancel lhe provision of any other stale or local�aw regulaling conslruclion or the per(ormance o( <br /> conslruclion. That I am authorized by the owner of this property lo peAorm the work(or which application is made and I comply with the <br /> Slate CoNraclors Law 18.27 RCW and 296.200 WAC. <br /> � � <br /> �r�_,� i� (� l�1A _ � <br /> Siy at`e of Ovmer o lra�t r/Aulhorized Agent Date <br /> \ <br />