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PE�2MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, =VERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM T04 PM <br /> SITE ADDRESS PARCEL TAX I.D.i� PERMIT N <br /> / 1 Z`� Q � r� � L. �f . 0�- d <br /> IEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> f�^rn��,a Q� ��K '71zy o\Y+�(� �� 0� . �ver� tt' qBLo3 �12-s-L3B•�ISy <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE M <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _ElecMc _Gas_Olher <br /> WORK DESCRIPTION <br /> Sewer ��f�ac.eJ�.et��' w �-l-\,;� n -�-�r. 0 �� uS � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXNRE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C—air handifng units <br /> Balhtub _ Forced atr syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Walarhealer <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas renge <br /> Clothes washer _ Clolhes dryer <br /> Water heater __ Range hood <br /> Sink(service/badmopletc.) _ Fzhauslfan <br /> Backflow preventar _ Heal pump <br /> Urinal _ Unil heator <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Retrigerelion <br /> Grease lrap _ Woodstove <br /> Roof dreins _ Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS]105 <br /> I horeby ceriti(y that I have read and examined this applicalion and know the same to be true and correct. All provislons ot laws and <br /> ordinaces goveming this lypo of work will be complied with whether specified herein or not.The granGnp of a pertnk does nol presume <br /> to giva aulhority to violale or cancel tho provision of any other stale or local law regulaUng consWctlon or the per!ortnance ot <br /> construction.That 1 am authorized by the owner af ihis property to perfortn the woric for which applicadon Is made end I comply with tlie <br /> State Contractors Law 18.27 RCW and 96200 WAC. <br /> � ���-��� Z�Zv - o� <br /> S'gnature of O r onlractor/Aulhonzed Agent �a« <br />