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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8657—www.evarettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> PARCEL TAX I.D.# ERMIT#/� <br /> SITE ADDRESS � JOO(.p ' O � <br /> 5 O 2 3 n2 �-' <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> TENANT NAME p 0%q N�eD CONTACT FOR PERMIT PHONE 3G� (�� � ZUQ 3 <br /> ��ry I SCO� RlCCR-T'' E-MAIL <br /> R R � <br /> A D E P <br /> �ONTR.LICENSE# ���� �/�� <br /> � <br /> I USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � _Electric _Gas_Olher � Q06 � <br /> WORK DESCRIPTION <br /> �, � �S � <br /> ( PLUMBING MECHANICAL <br /> NO. <br /> TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ?� Toilel _ �C–air handling units <br /> Bathtub _ Forced air systems <br /> Lavato (wash basin) Gas piping <br /> � ry Water heater <br /> Shower Gas fireplace <br /> j Kitchen sink&disposal — Gas range <br /> Dishwasher — Clothes dryer <br /> 1 Clothes washer Range hood <br /> � Water heater Exhaust fan <br /> I � Sink(servicelbar/mop/etc.) = Heat pump <br /> Backflow prevenler Unil heater <br /> Urinal Boiler <br /> _ Drinking Fountain Refrigerelion <br /> Floor drain Woodstove <br /> Grease irap — Other <br /> Rooi drains — <br /> 1 Other_j/t-AP ��l MGA — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby certify lhat I have read and examined this application and know the same to be irue and correct. All provisions of laws and <br /> ordinance�governing this type of work will be compiied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violale or cancel the provision of any olher state or local law regulating construdion or the performance of <br /> construction. hat I am authorized by the owner of lhis property to perform the work torwhich application is made and I comply with the <br /> State Conlr tors L 1827 RCW and 296.200 WAC. <br /> ,� - /4- ! D <br /> Signa ure of Owner/Conlractor/Authorized Agent Date <br />