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PERMIT APPLICATIt�N <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 /> SITE (A,D�RESS // n2 � PARCEL TAX I.D.# i �RMIT# � <br /> / � <br /> r� , (�0�5— S S <br /> LEGAL LOT O. BLOCK TRACT <br /> �ESC. <br /> OWNER ADURESS CITYIZIP PHONE <br /> TENA�NAM�� CONTACT FOR PERMIT PHONE <br /> �-�+� C�iw«,,.! �-t25- 32� -r��a� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.UCENSE# �G / 1/J J <br /> �C1�' <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � �Q� ��� _Electric _Gas_Olher <br /> WORK DESCRI ION � <br /> :/�` �!7("� S <br /> I X f.� �a,, v�-�-j ` � 2.� — <br /> PLUMBI G MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air tiandling units <br /> Bathlub Forced air systems <br /> Lavatory(wasii basin) _ Gas piping <br /> Shower Waler healer <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mopletc.) _ Exhaust fan <br /> Back9ow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinkiny Fountain _ Boiier <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceriti(y that I have read and examinea lhis applicalion and know the same to be lrue and cortect. All provisions of laws and <br /> ordinaces gove fi�g this type o(work will be compliod with whether specified herein or not.The granling of a pertnit does not presume <br /> to give authoriry in violale or I lhe provision of any other slale or local law regula6ng construction or the performance oF <br /> consWction:Th`at I am aulHoriz by the owner of lhis property to pedorm lhe work for which application is made and I comply wilh lhe <br /> Stale Cont�a�tors Law 18.27 R W and 296.200 WAC. <br /> �/ ��2 1 7 Z' l��'- /' <br /> Signat�s e offOwnedC,O lv�ctodAulhon gent Date �/� <br /> / % �' <br />