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PtRMIT APPLICATI(�N <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 B AM TO 4 PM <br /> SITE ADDRESS � PARCEL TAX I.D.# P�RMIT# <br /> S o�a .5������ /��e � o� � � -or� <br /> LEGFL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �,�, l`�ya� S ���� S�'v/I� /�✓c ����s�}_"9�2 9 3 <br /> TENAN'f NAME I CONTACT FOR PERMIT PHONE <br /> �7 E-MAIL q <br /> NTRA TOR �CO(/ ✓C'S P i'�h�7/r�fL DRES �1[17� �jl✓l��CS��4 ST�yP p N p�` 06 /� 2 <br /> / P ..SPc+�//P /Y�Of / � / � <br /> CONTR.LICENSE N � _ <br /> � �� -; - ,� �i <br /> USE OF BUILDING HEAT SOUkCE CONTRACT PRICE OF WORK <br /> Eleclric Gas Olher <br /> WORKOESCRIPTION � e�INCC W��-f� S<l✓'C�E� F«M ��e�f'� s� <br /> f 0 /J,� d <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Cbthes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(serviceNar/mop/elc.) _ Exhausl(an <br /> BackOow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> _ Grease trap _ Woodstove <br /> Roof drains / � _ Other <br /> Other WC�i �('r✓�LC' �� ,i-P <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihal I have read and examined Ihis applicalion and know Ihe same to be lrue and correcL All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specifieo herein or not.The granting of a permit does not presume <br /> to give aulhority lo violate or cancel the provision of any other state or local law regulating construc!ion or the pertormance of <br /> construclion.That I am authorized by lhe owner of lhis property lo pertorm lhe work(or which application is made and I comply with the <br /> Stale Conlractors Law 18.27 RCW a d 296.200 WAC. <br /> �� � �� �� <br /> i � � <br /> ' a ure o OwnedContraclod utl � ed Agenl Date <br />