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PERMIT APPLI(�ATIUN <br /> CITY O� EVERETT �ERMIT' 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 Zr� � <br /> SITE ADDRESS n PARCEL TAX I.D.# PERMIT# <br /> ;��// - 3 � ��. s:-f- M0� ���� I <br /> LEGAL�Lp7 N6. BLOCK TFACT OR SUBDIVISION!! � <br /> � � /• �� �.� 6 � <br /> DESC. ,/�pj�s� / ��� � <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �i�< - �-z� � � 5,�, �/ �5'�S 3��-- � � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE N ��� //�J/ //J� <br /> � ' '��, '/ -1��� <br /> USE OF BUILDING HEAT SOURCE CCIJTRACT PRICE OF WORK I <br /> _Eleclric �Gas__Other <br /> i <br /> — i <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE O�FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhlub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink 8 disposa� _ Gas fireplace <br /> Dishwasher Gasranye <br /> Clolhes washer _ Clnthes dry�r <br /> Waler heater Range hood <br /> Sink(sF:rvice/badmop/etc.) _ Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unil heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease Irap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CIT'f OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify ihat I have read and examined Ihis application and know the same lo be true and correcL All provisiuns of laws and <br /> ordinaces governing lhis type o(work will be complied wilh whelhei specified herein or nol The granling of a permit does not presume <br /> lo�ive aulhority to violate or cancel the provisiun of any olher state or local law regulating construction or the performance of <br /> wnstruclion.Thal I am aulhorized by the owncr of this property lo pedorm lhe work for�vhich applicalion is made and I comply with the <br /> Slate fiactors Law 1 27 RCW and 29G.2 � AC. <br /> �/'!i.; �j./^ > �-�� -�Z� <br /> naWre o Own Contre5to Authonzed Agen! Date <br /> I <br /> ----� <br />