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PE�N11T APPLICATIOI� <br /> ClTY OF EVcRETT 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 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL�AX I.D.# PERMIT# <br /> ���)`,�t'� �\ �� \ �� �'1 �7/ �� 'G�/ <br /> LEGAL L0T NO. BLOCK TRACT <br /> DESC. <br /> �>s� �a� � OWNER ADDRESS ` , CITYIZIP PHONE <br /> � 1��.,1�. �le�� I�1C� �-J�" �,I �= �--�-�� q � �-aJy-�- �k <br /> r;. � � <br />�:� <br /> ��.C.�� <br /> ,��. <br /> � TEN NT NAME CONTACT FOR PERMIT PHONE <br /> CONTRAC?OR ��� r�� C�c� DDRESS CITY/ZIP PHONE .��y��'� <br /> �i��l�� l`1��� ls�n���w�r_�-c� a8ca3�, -t4�-- ��7� <br /> - GONTR.LICENSE# <br /> '� ; <br /> � �; — <br />``�� ` JSE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br />'',�; ,� � <br /> ��":t• Electric ✓ Gas Other <br /> �... � — — <br /> WORK DESCRIPTION <br /> \�S�--a�� �aS ��z.���a�. 1n� �� <br /> PLUMBING MECHANICAL <br /> NC. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal �� Gas(ireplace <br /> _ Dishwasher Gas range <br /> _ Clolhes washer Clolhes dryer <br /> _ Waler healer Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> ` _ Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigerelion <br /> Grease frap Woodstove <br /> Roof drains Other <br /> i _ Other _ . — - <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined lhis applicalion and kno�v the same lo be lrue and correct. All provisions of laws and <br /> ordinaces governing this type of work wJl be complied wilh whether speciiied herein or not. The granling of a permit does not presume <br /> �give aulhority to viola e�6T�s�ncel the provision ot any other state or loca�law regulatinc�wnstruction or lhe performance of <br /> o struclion.That I am uthorv.ed by t e owner of ihis property lo perform lhe work for which application is made and I comply with the <br /> t te Contracto Law 1 . �V and 9G,200 WAC. , <br /> n tur of OwnedConlractor/Auth �qzed Agent Dale lo� 1 <br /> � �I <br /> � <br />