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PERMIT APPLICATION <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 <br /> �v�i r u'.f <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT M <br /> / J89o/ /�f / �] <br /> �.��D �� vG/��CS /�VG /// �� C��/ <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER �� ADDRE55 CITYIZIP PHONE S!,7S"t)7E'Y(-�7 <br /> �'n��r� ��l'����� o?��0 8 �o.�Ps . -�/v� �,�r.�<� rs�f 9�ao i <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E•MAIL <br /> T A ll <br /> CONTR. LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleciric ,�Gas Olher <br /> �ri��E — — <br /> WORK DESCRIPTION <br /> . -�nJ"�c�%� ���5 �i7G - <br /> PLUMBlNG MECHANICAL <br /> NO. 1 YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling units <br /> Bathtub Forced air systems <br /> Lavatury(wash basin) Gas piping <br /> Shower Wat�r heater <br /> Kitchen sink 8 disposal � Gas freplace <br /> Dishwasher Gasranga <br /> Clolhes washer Clolhes dryer <br /> Water healer Range hood <br /> Sink (service/bar/mop/elc.) Exhausl fan <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> _ Drinking Fountain Boiler I <br /> Floor drain Refrigeration <br /> Grease irap Woodstove <br /> Roof drains Other <br /> Other—---- — <br /> CITY OF EVERETT IOCAL SAIES TAX CODE IS 3105 <br /> I hereby certify lhal I have read and examined tnis applicalion and know the same to 6e true and correcL All provisions of laws and <br /> ordinances governing ihis lype of work will be complied wilh whether specified herein or not.The granting of a pertnit does not presume <br /> to give aulhority lo violale or cancel ihe provision of any olher state or lecal law regulating construciion or the peAormance of <br /> conshuclion.Thal I am authorized by the owner ot Ihi�property to perform the work for which application is made and! comply with the <br /> State Contractors Law 1827�;CW and 296.200 WAC. <br /> ,'L�r.� l'��"1!� . .i� _ // !/ ,�o/U <br /> Signalure of Owner/CoNmctor/Authorized Agent ate <br />