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A <br /> PE�rtMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, \NA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# /P��RMIT# <br /> Lbnt C�.4.cs /I�c�_ ��rel�f� wA q5�� C�ti'�7"d�� <br /> LEGAL LOTNO. BLOCK TRACT <br /> OESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> K��t� G..�� zeo� a.t�� �� F,,��tt CI�'l� i CtizS�y►S-2o�S <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOUP.CE CONTRACT PRICE OF WORK <br /> I �� k _Electric �Gas_Other 2��0 � <br /> WORKDESC IPTION ��,,,�,r;- �,�I� �zi.., Rt�. �,n`-v (�,,,PI[r <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> � Lavatory(wash basin) Gas piping <br /> I Shower �_ Waler healer <br /> J_ Kitchen sink 3 disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> � Clothes washer � Clolhes dryer <br /> Laundry tray � Range hood <br /> Sink(service/barlmop/etc.) � Exhaust tan <br /> Backflow preventer _ Healpump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> � Floor drain Refrigeration <br /> I Grease trap _ Woodstove <br /> Roof drams Olher <br /> Other <br /> � — <br /> ' — � <br /> ; CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i I <br /> I hereby ceritify that I have read and examined this application and know the same to be lrue and correct. All provisions of laws and I <br /> ordinaces governing this type of work�vill be complied with whether specifed herein or not.The granting of a pertnit does not presume <br /> ro give authority to violate or cancel lhe provision of any olher state or local law regulating construction or the pertormance of <br /> construction. That I am authorized by the ov+ner of this property to perform the work tor tivhich application is made and I comply with the <br /> State Cont� rs �418.27�96.200 V'JAC. <br /> Ii �� <br /> � <br /> Sigqa4 r of neuConUactodAulhorized Agent �ate t l <br /> �� <br />