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PE� .IIIIIT APPLICATIOh <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857—www.everettwa.ory <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��'I.% "�S <br /> SITE ADDRESS _ � �y,� _ I PARCEL TAX I.D.# PERMIT# _� <br /> •Z�:� �-�-� 5 l.� ��,� Z�l �'� 7`1 c=w qi:;u �. � --,,� - J <br /> LEGAL LOT NO. BLOCK TRACT <br /> �ESC. <br /> WNER ADDRESS CIN21P PHONE I <br /> L���� C� ��.L-- � � <br /> TENANT NAME � CONTACT FOR PERMIT PHONE i <br /> � <br /> CONTRACTOR � �-�S� " ��APDRESS CITY2IP PHONE <br /> CONTR.LICENSE# `�/��� /�� , ��� � <br /> fi W <br /> J � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> ._ ' � h <br /> ���,�n-� I � :� �..��v�hc�.<<3 e� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhtub Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&dieoosal Gas(ireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Laundry iray Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br />� Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> I _ Floordrain _ Re(rigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CI7Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined lhis applicalion and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governing this rype o(work will be complied with whether speci(ied herein or nol ihe granling of a permit does��ot presume <br /> to give aulhority to violale or cancel the prGvision of any other state or local law regulating conslruclion or the pedormance of <br /> consiruclion.That I am aulfjorized by he qlvner of lhis property to perform lhe work tor which application is made and I comply with lhe <br /> State Contractors L�ayr 1 7 t��W d 29�.200 WAC. <br /> / � <br /> �'; �'.�'�`' '� l� l� �� <br /> �c�nature of Uv edCo racrodAuthorized Agent Ua \ <br /> l� <br /> - . . � - <br />