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� � <br /> P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERM M <br /> � �"i7 � 0� -D (� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> � � �'! � � �> >� � _ <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> _� A �3 � <br /> E�NIAIL <br /> CONTR.UCENSE N �'l�r 1�p� <br /> �.l lJ t� <br /> USE OF BU�LDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> .1--1 l���i _Eleclric _Gas_Olher <br /> IIV <br /> WORKDESCRIPTION ��Ir,_'LIs�C� ,U�;r-u Feb 1�l 1Z <br /> ���Stc�ll � ��XX�I `�U�� �2�i��t Z�i�ut�� tiic�lel GI.Ok-ItiC�ScOH <br /> ���'DI �11D'� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. I TYPE OF FI%TURE OR ITEM <br /> Toilel A/C—air handling units <br /> Balhlub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas tireplace <br /> Dishwasher Gasrange <br /> Clothes washcr Clolhes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mop/elc.) _ Eahaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unil healer <br /> Drinkinc� Fountain _ Boiler <br /> Floor drain Retrigeration <br /> _ Grease Irap � Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> 1 hereby ceritify that I have read and examined this application and know lhe same to be We and correct. All provisions of laws and <br /> orAinaces governing this type o(work will be complied with whelher spocified herein o�nol The granting of a permit does not presume <br /> to give aulhority to violate or cancel lhe provision o(any other state or local law regulating consWction or the performance et <br /> conslruction. That I am authorized by the owner o(Ihis property to pertorm C�a work for which application is made and I comply with the <br /> Stale Contractors L��27 RCW and 29G200 VJAC. <br /> :��.r; �� � t � l, c,ni1���� 1 �21�-1�� <br /> Signawre of Owner Con ractor/Autlionze�Agenl Date <br />