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� ERMIT APPLICAI �JN <br /> CI7Y 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 - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT � <br /> iv s�U � � ��� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER /� ADDRESS 1/� _ CITY2IP PNONE <br /> �GG�GL 7l�"UL i,(/1/J `��G��� � 70�5 l �-1/ /Vc <br /> TENANTNAME CONTACiFQR ERMIT PHONE � <br /> - I ,�1���` <br /> CONTRACTOR �� �n JGI'n,�u ADDRESS CITY2IP PHONE <br /> � <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FO(TURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry trey Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease tra Woodstove <br /> P � <br /> Roof drains � ) � Other <br /> _ Other .`> '/' ' (� '�� V� — <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS J105 <br /> r <br /> � I hereby ceritify that I have read and examined this application and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified here r�c.r not.The granting of a permit does not presume <br /> to i authonry to violate or cancel the provision of any other state or local law reyula0��g construcUon or the performance of <br /> nst ction'7hat I am authorized by the owner of this property t perform the work for which application is made and I comply with the <br /> Stat C o( ctors Law .27 Q�61.and 296.200 ,C. <br /> , �� /� ' - .(� DS� <br /> a <br /> i t e of Owner/Co tor/huthonzed Agent te , <br /> � <br />