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( � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES v <br /> 32Q0 CEDAR STREET, EVERETT,WA 98201 � <br /> 425-257-6810—FAX 425-257-8857—www.everettwa.org 1'�I " � `� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��0�� � '�j <br /> SITE ADDRESS ��� PARCEL TAX I.D.# �PER IT 1F � <br /> LEGA 1.0T NO. BIOCK TRACT OR SUODIVISIOK/ <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE � 7 L i <br /> �l.tG Pt1�PsM 7�/� �. ��N� v�t�va; cvrr��7'�qb'���fx�8o� <br /> TENANT NAME I CONTACT FOR PERMIT PHON�ys�Z�3 000 <br /> �)�� VI E-MAIL <br /> CONTR.LICENSE k <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _,Gas_Other �/0 I� d��G� <br /> WORK DESCRIPTION ���� �� n — �n� � �.� L m��G � ' � e� <br /> wWI� r <br /> "rd <br /> �i.)c'!.f-iNlT �'"a�' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C–air handling units <br /> Bathtub _, Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kilchen sink 8 disposel _, Gas fireplace <br /> Dishwasher _ Gas range <br /> Clathes washer _ Clothes dryer <br /> Water heater _ Range hood I <br /> Sink(service/bar/mop/etc.) _ Exheust fan <br /> Backflow preventer _ Heat pump <br /> Urinal ,_ Unit heater <br /> Drinking Founlain _ Boiter <br /> Floor drain _ Refrigeration <br /> Grease lrap _. Woodstove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> 1 hereby ceAify that I have read and ezamined this application and know the same lo be true and corred. All provisions of laws end <br /> ord� ances goveming lhis rype of work will be comolied with whether specified herein or not.The granting of a pertnit does not presume <br /> to g�ve authority to violate or cancel the provision of any other�tate or local law regulating rnnshuction or the perfortnance of <br /> construction.Thal I am authorized by the owner of this propen�to perform the work for which application is made and I comply with the <br /> State Contaclors Law 18. RC and 296.200 WAC. <br /> J°� �� � <br /> Signature of OwnedContracto�:�•dhorized Agent Date <br />