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PE�tMIT APPLICATIOh <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 /> SITE ADDRE PARCEL TAX I.D.# PERMIT# <br /> ' ��Cci�t � �� 'G <br /> LCGA LOTNO. BLOCK TRACT <br /> DL SC. <br /> OWNER ADORESS CITY2IP PHONE <br /> !/�t, /I c r� �d�i� � ��;�, l2u��� 1���_, e rf- �lzs �caz�a� z <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> / Lf �t t 7`�--' <br /> CONTRACTOR AODRESS CITYIZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> ElecUic Gas Olher <br /> WORK DESCRIPTION <br /> �{- < . g (t� , Sw, �� �t , S� ee-� �2 �� I-� w t.F ( IS <br /> �� � I C L �" � L C��L � <br /> c e � /� �,,5 F � �,� � ti L �a��..�� ��c�+,�.� . �v�� i� lu W, �� .� -�e.v -�.�.�-� - <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. IYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Balhlub Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water hea�er <br /> Kilchen sink 8 disposal Gas Tireplace <br /> Dishwasher Gas range <br /> Clothes washer � Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/badmop/etc.) _ Exhausl fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease Irap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity lhat I have read and examined this appliwtion and know the same to be We and correcl AII provisions of laws and <br /> ordinaces goveming this type o(work will be complied with whelher specifed herein or not Tha granling of a permit does nol presume <br /> lo give aulhonty to violate or cancel Ih� Nrovision of any other slate or local law regulatiny construclion or the performance of <br /> construction.Thal J am aulhorized by the owner of this property to perform the work for which application is made and I comply with the <br /> Slate Conlractor�L�aw 18.27�CW and 296.200 WAC. <br /> L�L Z.L {�L�,C,�� <br /> Signature of OwnerlContractor/Authorized Agent Date <br />