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F _..RMIT APPLICATI( .V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE'TT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPL�CATIONS ARE ACCEPTED FROM 8 AM TO 4 PM s_.�-�`�� <br /> SITE ADORESS J PARCEL TAX I.D.!1 PERMIT# <br /> ,,,, C� �<" 1��. � �� ' b�.2. <br /> LEGA LOT NO. BLOCK TRACT OR SUB�IVISION# <br /> OESC. <br /> OWNER -% ADDRE5��5� CITY/ZIP NONE <br /> ��`���' ���'i ���Ot' ��� `/�'���1�� �i/��7- ,�?s'�r.z��y�, <br /> ENANT NAME <br /> T CONTACT FOR PERMIT PHONE <br /> ����( � E-MAIL <br /> ��� I I <br /> CONTR.LICENSE N ��7 ���" ' " <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �j- ��,�(��{����1� ��si��IJ� I —Electric _Gas_Other <br /> WORK DESCRIPTION �� <br /> ����� �� � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ NC–air handling units <br /> Bathtub _ Forced air systems � <br /> _ Lavatory(�'+ash ba�in) _ Gas piping ' <br /> Shower _ Water healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes Aiyer / <br /> _ Water healer / _ Range hood <br /> Sink(service/badmop/etcJ _ Exhaust fan <br /> Back(low prevenler _ Heat pump <br /> Urinal _ Unit heater <br /> _ Drinking Fountain _ Boiler <br /> Floor drain Refrigera�ion <br /> Grease Irap _ Woodstove <br /> Roof drains _ Olher <br /> O�h�r — <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby certify that I have read and examined Ihis application and know Ihe same to be true and correct. Ail provisions oi laws and <br /> ordinances goveming Ihis lype of work will be complied with wheiher specified herein or not.The granting of a permil does not presume <br /> to give authority to violate or cancel the provision o(any other state or local law regulating construction or the performance of <br /> construction. Thal I arf�au�ho`lzed b tho'owner ot t " �ertp�to perform the work for which application is made and I comply with the <br /> Slale Cor�adors Law 162J/RCW�nd Q96.200 If�'.� �.' <br /> � � <br /> G� � %(./,- �( - <br /> S�jnature of Owned on raGor/ ih6rKed geht _ _ Date }' <br /> � �L- <br /> �-- <br />