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P�rtMIT APPLICATIO�� <br /> CITY OF EVERETT PERMIT SERViCES <br /> ' 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org '`i Q�5 <br /> APPLICATIONS %,RE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED I <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# i <br /> � ^ �Q <br /> p AUF. ��e�'s- � O � �� ��-/ <br /> LEGAL LOT NO BLOCK TRACT � <br /> DESC. C'CC D-D�� <br /> OWNER ADDRE55 CITYIZIP PHONE <br /> � y,� 7io •(,P,o7 <br /> r� � + (�it � � V �rv�c� � Lt�C7� �a�l�i'S�� ��UF fuPrC� �003 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �l ClS CVf� lC�f <br /> CONTRACTOR � I n ADDRESS CITYRIP PHONE <br /> �>- �_ <br /> CONTR.LICENSE# �pn�J CfS �'�{:�>i�� ��n�p G�S I��F:��A- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���� '"'��-�� L' � _Electric �Gas_Other <br /> WOR DESCRIPTION <br /> � <br /> �.� , , � ,- , r�,.. r, �ar>> �� � <br /> PLU BING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> I Toilet A/C-air handling units <br /> ( Balhtub Forced air systems <br /> � Lavatory (wash basin) � Gas piping <br /> � Shower Walerheater <br /> � Kitchen sink&disposal ?, Gas fireplz;e <br /> i Dishwasher � Gas range <br /> y Clothes washer � Clothes dryer <br /> Laundry tray Range hood <br /> � Sink(service�barlmopletc.) � Exhaust fan <br /> � Backtlo�.v preventer _ Heat pump i <br /> ' Urinal Unit heater <br /> �' Drinking Fountain _ Boiler I <br /> � i Floor drain _ Refngeration i <br /> I Greasetrap Woodstove <br /> I Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritii��that I have read and examined this application and know the same to be true and correct. ,411 provisions of laws and ; <br /> ordicaces governing this type of work will be complied wiih whether specified herein or not The granting of a permil does not presume I <br /> to give authonf�to violate or cancel the provision of any other state or local law regulating construction or the pe�tormance of � <br /> construction.7hal I am authorized by the owner of ihis property to perform the work for which application is made and I comply with the � <br /> State Contractors Law 1827 RCW and 296.200 WAC. <br /> �� � � (E � %Z �' it�-o�I <br /> �."t �r �' �' / -C'�=" <br /> Signature of Owner;ContractoriAuthonzed Agent Date I <br /> \ <br />