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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 S'� �-O� <br /> SITE A�JDDRESS �/ PARCEL TAX I.D.A P MIT/ <br /> S`Q �JLC.� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDMSION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��e77' �/D�/S ��J� Z is2o d4�'ES . <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> ��-�'�� �,�oi a.�9-c�- <br /> CON AC OR ADDRE33 C I PHONE <br /> c�u�rc5�nc YJ.��l��ap�vc. lb� `��� ��Z23 �?5=�4�-7 >? <br /> CONTR.LICENSE# <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRI�E OF WORK <br /> �"'� (o — — — EF.1 <br /> U Electric Gas Other ld/ OG�J � <br /> WORK DESCRIP ION <br /> IZ�S� �Ew�S <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathlub Forced air systems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> � Water heater Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> 7 Backflow prevenler _ Heal pump <br /> �� Urinal Unil heater <br /> Drinking Fountain Boiler <br /> '� Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES T/U(CODE IS 3105 <br /> I hereby cerilify lhat I have read and examined this application and k�ow lhe same to be true and cortecl. All provisions ot laws and <br /> ordinaces�oveming lhis lype of work will be complied with whether specified herein or nol.The granling ot a pertnit does not presume <br /> to give authority lo violale or cancel the provision of any other state or local law regulating construcUon or the perfortnance of <br /> construction.That I am a horized by the owner of lhis property to perform the work for which appllcaBon is made and I comply wilh lhe <br /> Slate Co ractors Law 27 RCW and 296.200 WAC. <br /> ��'��� a�rl.�Ot� �-/4�O'7 <br /> SignaWre of OwneAContraclodAuthorized Agent Oate <br />