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PERMIT APPLICA�'ION <br /> CITY OF EVERETT PERM►T 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 ��..I � —D � <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ( � � �S— �— d . 'D z7 O-� � � 7/�. ' (�/S <br /> LEGAL LOTNO. BLOCK TRAC70RSUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ��F 2Gy 1��.� &�� �J s f�3�� � ���� `�?v�1 ��� <br /> TENANTNAME CONTA FORPERMIT PHONE <br /> _�� ���1)(�,L�l� ���`�'' ���� ��SSd� <br /> �' E-MAIL <br /> CONTRACTOR ADDRtSS qTY21P PHONE <br /> � <br /> CONTR.LICENSE# /Ji,� '/�:-=J <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WURK <br /> c� <br /> ���6��.��_ �Eleclric _Gas_Olher <br /> WORK DESCRIPTION <br /> i <br /> � % I <br /> /': <br /> �,.;, , � � <br /> ����� -�- <br /> PLUMBING MECFiANICAL <br /> NO. TYPE OF FIX?URE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> � Bathtub � Forced air systems <br /> � Lavalory(wash basin) Gas piping <br /> Shower T Water healer <br /> �_ Kitchen sink F disposal Gas tireplace <br /> 1 Dishwasher Gas range <br /> � Clothes washer I Clothes dryer <br /> � �Nater healer � Rariye hood <br /> Sink (service/bar/mop/etc.) � Exhausl fan <br /> Backllow preventcr Heat pump <br /> Urinal Unit heater <br />� _ Drinking Fountain Boile; <br /> _ Floor drain �y_ Refrigeration <br /> Grease trap Woodstove <br /> Roo�drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this applicafion and know Ihe same to be true and correcl. All provisions of laws and <br /> ordinaces goveming lhis type of�vork will be complied with whelher speci(ied herein or nol.The yrantina nf a permil does nol presume <br /> to c�ive authority to violate or cancel the provision of any other state or local law regulaling constniction a lhe periormance o( <br /> consVuclion. That I am authorized by th owner o(this property lo perform the work(or which applicalion is made and I comply wilh ihe <br /> Stale ConlraclorsL•w 1 CW 29 0 WAC. ' <br /> L������ ��� ��'/��- <br /> Signat�� nedContractodAuthorized A9ent Date � <br /> /Z <br />