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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES G �� � <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 �,� I IU6-U 0 � <br /> SITE ADDRESS PARCEL TAX I.D.N PE MIT� <br /> 11�Z 1�t-1tiw:�it, /�uc,n✓` OG�13f�C� - �•-l � - c� i � - ciZ I! — <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION K <br /> DESC. .� (r/�^� QI.�} cI YJE•t�t{- �r+'.bc�' L <br /> OWNER ADDRE53 CITY2IP PHONE <br /> ' t3 n�� t-�c,���� t� A�^Y F��t 1�;T_t�.L�:r� .qv+., `i��r.x./-F `1�i i:0] <br /> TENANTNAME I CONTACTFORPERMIT PHONE NZ) ,[:�C� CYiGI <br /> ����c:� �"�L'v�`� E�IIAIL �0��[C�fl'ch� �4:�M^W�. <br /> CONTR.LICENSE• ��7 'C�� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> `��,��,.,cz, I _Electric _Gas_Other /� �J� � <br /> WORK DESCRIPTION <br /> —, Z.•.,- ��..1� :,��� ��,✓�•7 L. .•..,� �n J� ri/ �•, ./V+�✓ (�1�•,,,�L� . <br /> / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OP FIXTURE OR ITEM <br /> Toilet _ NC-air handling units <br /> Bathlub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Clothes dryer <br /> Water heater _ Range hood <br /> I Sink(servicelbar/mop/etc.) _ Exhaust han <br /> Backtlow preventer _ Heat pump <br /> Urinal _ Unil heater <br /> Drinking Fauntain _ Boiler <br /> i Floor drain _ Refrigeration <br /> Grease:rap _ Woodstove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7706 <br /> I hereby certify that I have read and examined lhis applicalion and know lhe same to be true and correct. All pravisions o1 laws end <br /> ordinances governing lhis type of work will be compiied with whether specified herein or nol.The granting of a pertnit does not presume <br /> to give suthority lo vidate or cancel the provision ot any other slale or local law regulating construdion or the perfortnance of <br /> construction.That I am aulhorized by the owner of this property to peAorm the work for which application is made and I comply with Ihe <br /> State Contredors Law 18.27 RCW and 296.200 WAC. <br /> %� � �-,��.1� �- I`i - �l ( � <br /> Sign e of Owner/Contract uthonzed Agent Date � <br />