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PERMIT APPLIC�►TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everetr+va org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CF:EDIT CARDS ARE NOT ACCEPTED <br /> PARCEL TAX I.D.# PERM T# � <br /> SITE ADD�ESS n � /� � '^^ �� _ ��� � <br /> � � r \ <br /> ��( ,� i�C�)[��;� C` �-f,' <br /> LEGAL LOTNO.�BLOCK TRACT <br /> DESC. <br /> OWNER AUDRESS CITYlLP PHONE <br /> ���i_ .Il ` _ . . � ll� ` .. �_ � � _�( ;� y�c (. 1-;'i;' � I ��)_7" �i�" J`� � <br /> (< ' . <br /> TENANTNAME � I CONTACTFORPERMIT PHONE ` <br /> ,�„� �I! 1., . � - '� �:��„ I .�'_-�_ �>�� <br /> ADDRESS -�: ., I, i��� -r.'�-� _CITY2IV- PNONE <br /> CONTRALTOR j � — � _ - _ i � � � � _ <br /> . ��: _ Lf �� ( ���. � Pz _ .Z.i_f?,''_ ._ .. _-� �:� - <br /> CONTR.LICENSE p ' � ���� Z� <br /> � <br /> _ •�,.��U'' � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ,� � � �� : �.. ; . — <br /> Eleclnc Gas Olher '- ;,��. . .� - <br /> WORK DESCRIP710N .�. _� � , �, ..�,��, . � -� ,-,f '. <br /> r �, l_ �i` � i_ �1. .��li , � ��. i . �.� �� �.(� , . _ �• . , . r(�_ 1=_ , , . <br /> - i - <br /> -ir :��. . i ��' � � , � ;/,J.�_ ���, . �� \ • <br /> i �- � <br /> PLUMBING MECHANICAL <br /> NO. IYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet _ A/C-air handling units <br /> BathWb I Forced air systems <br /> Lavalory(waeh basi�) _ Gas piping <br /> Shower _ Water healer <br /> Kitchen sink 8 disposal _ Gas fireplar,e <br /> Dishwasher _ Gas range <br /> Clothes washer __ Clothes dryer <br /> Laundry Iray ___ Rarx�e hood <br /> Sink(service/badmopletr,.) _ Exhaust lan <br /> Backflow pr�vonter Heat pump <br /> Urinal ___ Unit heater <br /> Drinking Fountain _ Boiler <br /> Floordrain ___ Refngeration <br /> Grease hap _ Woodstove <br /> Roof dreins Olher_. <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 1705 <br /> I hereby ceriti(y ihal I hava read and examined this application and know the same to be We and corrr,ct. All provisions of laws and <br /> ordinaces goveming ihis�ype oi work wdl be complied with whether specified herein or not.The granting of a pertnit dces nol presume <br /> to give authonty�o violate or cancel Ihe provision of any olher state or lecal law regulatinc�wnstruction or Ihe pedorriance of <br /> construction.That I am authorized by the owner of Ihis properry to perlorm ihe work for which application is made acd I comply with the <br /> State CoNraclors Law 7827 RCW and 296200 WAC. <br /> . { <br /> �� , ,_ �: ; . , . .�rv !( �J L 'I <br /> Signature of Owner ontraclo(IAulhonzed Agenl Date <br />