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P�R�VIIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEFETf, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS ' � PARCEL TAX I.D.# PERMIT# <br /> f� - �, ;���(�� � ���-�(�o5- c�a <br /> LEGA LOTN i BL CK TRACT � �, t�y <br /> DESC. I �Ii% �I �Vl� � <br /> OWNER � � / ADDRESS � / � qTY21P PHONE <br /> 1�� 1 � `� ��;,r '���Il� � f;v���,f:�� ��'�7���'<�l <br /> �_f1 <br /> TENANTNAME � CONTACTFORPERMIT PHONE � <br /> —�rI—�a <br /> CONTRACTOR 1 ADORESS CITY2IP PHONE <br /> CONTR.IICENSE p <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> r j� 1� V�Electric Gas Olher <br /> 1/� ,� - <br /> WORK DESCRIPTIONI � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> � Toilet i � � _ A/C—air handling unils <br /> �athtub Forced air systems <br /> .�. Lavatory(wash basin) � _ Gas piping <br /> �! Shower, ,�'� _ Waler heater <br /> �L Kilchen sink&Cisposal � _ Gas fireplace <br /> �/ Uishwasher � _ Gas ranc�e <br /> � Clothes washer � _ Clothes dryer <br /> __;,�_ Water he�ler I _ Range hood <br /> ./ Sink(service/bar/moplelc.) Exhausl�an <br /> Backllow prevenler Heal pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> RooF drains Other <br /> Olhcr <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined)tiis application and kno•,v the same to be lrue and wrrecL All provisions of law� and <br /> ordinaces goveming Ihis lype o(work will be cdmplied wilh whclher speci(ied herein or nol.The granting of a permil does not presume <br /> to�ive aulhorily to viol2le or cancel lhe provision of any;Dther slate or local law regulating consWction or the pedormance of <br /> construclion.Tha)I am authorized by tho;nwner ol Uiis'property lo pertorm ihe work for which applicalion is made and I comply wilh ihe <br /> State Contractors'�aw 18.27 RCW and 29G.200 WAC. <br /> ._ /� . . ' ' '`�� <br /> / <br /> �� ,y ` �,t �� �.. /1, c i. <br /> SignaWre of OwnedCoptr2c or{A Ihorize A�ent Dale <br /> .-� <br />