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PERIMIT APPLICATION <br /> CITY OF EVERETT PERMIT SER�ICES <br /> 3200 CEDAR STREET, EVERETT, WA 982C <br /> 425-257-8810- FAX 425-257-8857 -v�rv�w.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM / �/� _/�� <br /> SITE A DRESS , PARCEL TAX I.D.# PERMIT# �. <br /> I �(J � � i�� F; � . , � <br /> LEGAL LOT NO. � BLOCK TRACT OR SUBOIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> a � , -( y��� IIF��K'���e �v [-�IPd��f, ��ll� ��'IQ3 yl5- '��- ��ll <br /> ���� <br /> ENAN NAME CONTAC FOR PERMIT PHONE .��!)_ i7�-C7 17q i/ <br /> �� _ G L L! <br /> �- C : . , - _ / — � i � <br /> `J / E•MAIL <br /> 'C T CTOR � I ' ADD E S - CIN/ZIP PHO <br /> i <br /> 1 <br /> CONTR.LICENSE N <br /> USE OF BUILDING ,•'i��� �" 1T SOURCE CONTRACT PRICE OF WORK <br /> �_��1�����`..�;�Lr ��� .!��1��� ✓ Elecd ✓ Gas_Other <br /> J — <br /> —� <br /> WORK DESCRIPTION <br /> �t��������lir��� ��i �I���� ��a���Je �n-�o G� l��dra�n�� C1��d 5forc�e �Y�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Balhlub Forced air systems <br /> Lava�ory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas freplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> Water healer Range hood <br /> Sink (scrviceNar/moplelc.) Exhausl fan <br /> Backllow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinkinc�Founlain Boiler <br /> Floor drain Refrigeralion <br /> Grease irap Woodslove <br /> Roof drains Other <br /> Other <br />� — CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I herehy ceritify ihal I have read and examined this application and know the same to be true and correct. All proeisions o(laws and <br /> ord� �ic2s governing this type of work will be complied wilh whether specified herein or not.The granling of a permil does nol presume <br /> t��-. •e aulhority to violale or cancel lhe provision o(any olher stale or local law rec�ulaling conslruclion or the periormance of <br /> ..�, uclion.Thal I am aulhorized �y lhe owner of lhis property to perform the work for which applicalion is made and I comply with the <br /> Sta�e�onlrac ors Law 10.27 RCW and 296.200 WAC. <br /> i <br /> � � 1 .) �_ r�.._ /1 �� -� <br /> Signal ,rep OwnedCon clndAuthorized Agenl Dale � <br /> ��� �l <br />