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PERMIT APPLICATION <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 /> PARCEL TAX I.D.if PERMIT ii � <br /> SITE ADDRESS � , �� — � � <br /> j., �Z R �V<< v �••c�.l �IJL <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. C17y�Z�p PHONE <br /> AUDRESS <br /> OWNER �r ZS- �Z 7' (�IZ <br /> M \ ' e< �2-13Z 1�2'�,.<r v � �., Q1� .1. F�e�c�4 `�SZu3 <br /> \ � \'.1��L � �1 5 2� PHONE <br /> TENANT NAME I CONTACT FOR PERMIT <br /> E•MAIL <br /> ADDRESS <br /> ITYIZ P PH NE <br /> CONTRACTOR <br /> CONTR.LICENSE# /��,f-C>2� <br /> L I CONTRACT PRICE OF WORK <br /> USE OF BUILDING <br /> I — HEATSOURCE <br /> Electric _Gas_Olher <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> N�� TYpE OF FIXI"URE OR ITEM <br /> NO. TYPE OF FI%TURE OR ITEM <br /> A/C—air handling units <br /> Toilel � � Forced air syslems <br /> I _ 6alhtub • �_ Gas piping <br /> I — Lavatory (wash basin) �� Waler healer <br /> Shower �_ Gas tireplace <br /> _ Kitchen sink&disposal �� � Gas range <br /> _ Dishv+asher � � Clolhes dryer <br /> Clothes wosher Range hood <br /> Water healer Exhaust(an <br /> Sink(serviceNadmopletc.) — Heat pump <br /> F3ack(low preventer Unit heater <br /> Urinal Boiler <br /> Drinkinc� Fountain — Refric�eration <br /> Floor drain W oodslove <br /> Grease lrap Olher� <br /> Roo(drains — <br /> Olher�_-- <br /> — — =I — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity that I have read and examined this application and know the same to be true and correcl. All provisions o(laws and <br /> to givecauthority lo�io1late o4r cancelr lielprovis on oif any o1lherlstate oPlooal aweregu ating con�sWction o�the pertormance of Presume <br /> conslruction.That I am authorized by the owner of this property to pertorm the work(or which application is made and I comply with lhe <br /> Staye Contr r aw 18.27 RCW and 29G.200 WAC. <br /> / �'\�`J�' I ( �I �0� <br /> ��naWre ot OwnedConlraclodAulhur¢ed Agent <br /> Date <br />