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� P�RMIT APPLICATIUN <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 /> APPLICATIUNS ARE ACCEPTED FROM 8 AM TO 4 PM � � p` `I i <br /> PARQ L TAX I.D.# PERMIT.�t <br /> SITE ADDRESS � l ,/ � 'i � <br /> ���;< i�l/,G^/itG /'� ; � 1/ �7Su '�c%7'�J _`!i� ��'S �� � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESc CITYIZIP j� PHONE <br /> ^ i ; /,;.>� � 'iln;-�.,y �� �1°� �a,�;�o/ ��� �`��� �lL�! � <br /> 1,�.�,��.,,,:.-i =�� �v.�, <br /> d--. �--o. <br /> TENANTNAME CONTACTFORPERMIT PHONE / <br /> �fa� a�a - UG�I�. <br /> C�:.,�:t�-�(�� E•MAIL __Z <br /> CONTRACTOR ADDRESS CITYIZIP PHO E <br /> CONTR.LICENSE# � <br /> �/L,L��'-"' <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �. ,�� �, �� ,-�,�,:.,�.-..� Electric _,_Gas_Other <br /> � � �iE�'� ' f�;.__.. — <br /> � <br /> WORK DESCRIPTION <br /> � � � , �``,':,'. r•��- <br /> � � ; ������= <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITE�YI NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A!C—air handling units <br /> Balhlub _ Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Waterhealer <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clolhes washer _ Clolhes dryer <br /> Waler heater _ Range hood <br /> Sink(servicelbar/mop/elc.) _ Exhaust fan <br /> Backflow preventer _ Heal pump <br /> Urinal _ Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> = Olher I = — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 ��, <br /> I hereby cerilify lhat I have read and examined this application and know the same to be We and correcl All provisions of laws and <br /> ordinaces govemine� lhis lype o(work will be complied with�vhether specilied herein or noL The grantiny or a permit does nol presume <br /> b give authority to violate or cancel the provision of any olher slate or local law regulaling construction or lhe performance of <br /> ror,struction. That I am aulhorized by the owner of this property lo pertorm the work for which application is made and I comply with lhe <br /> Slatc Contractors La�v 16.27 RCW and 296.200 WAC. <br /> S�gnature o(OwnedContraclor/Authonzed Agent Date � <br /> / Ci <br />