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PERMIT APPLICATIVN <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 //,lC��J��� <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org ( �J <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS , PARCEL TAX I.D.# P MIT <br /> �`� I J • -' . <br /> C. �AL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AUDRESS CITYIZIP PHONE <br /> ' �n /Y�fns �v � /9�9, �v�� �/Gt 9��� ��zf 3ssy��o <br /> TENANT NAME C�Oj TACT FO PERMIT PHONE <br /> cJ,,�r,`� �en �'J� r r rS _ ' ` <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BU'LDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> G��Q�� d-S��G�G _E�ectric ZCGas__Other �'G��� <br /> WORK DESCR PTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF F�XTURE OR ITEM <br /> �_ Toilel A/C—air handling units <br /> _ Balhtub Forced air systems <br /> Lavalory(wash basin) �C Gas piping <br /> Shower Waler hea�er <br /> Kilchen sink&disposal Gas firepiace <br /> Dishwasher _ Gasrange <br /> Clolhes washer Clolhes dryer <br /> Waler healer Ranc�e hood <br /> � Sink(service/badmop/etc.) _ Exhausl fan <br /> BackOow preventer Heatpump <br /> Urinal �r Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeration <br /> Grease trap Woodstove <br /> Roo(drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES T1UC CODE IS 3705 <br /> I tereby cerilily lhal I have read and examined this application and know the same to be true and correct. Ail provisions of laws and <br /> ordinaces c�overning this type of work will bo complied wilh whelher specified!ierein or nol.The granling of a permi�does nol presume <br /> to give authority to violale or cancel the provision of any olher state or local law reguiating construction or the performance of <br /> constiUction.Thal I am aulhorized by lhe owner ot this property lo peAorm the work for which application is made and I wmply wilh the <br /> State Contr lors Law 18.27 RCW and 296.200 WAC. <br /> �_ ' /�_ �/b L�� <br /> Sign ture o Owner/„onlraclodAuthorized Agenl �e <br />