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� P�RMIT APPLIVATI("V <br /> CITY OF EVER�TT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AIYI TO 4 PM G `� �� <br /> SITE ADDRESS �„(� PpRCEL TAX I.Dp.#p PERMIT q <br /> �i Q .�i �9� �00 �� , QU I 1?i(�calxc—G3lG <br /> EGA LOTNO. •f0 � BLOCK TRACT <br /> oesc. / -� � .� ,o D .�U <br /> OWNER j��• / ,(� ADDRESS CITV2IP PHONE i/�(�' <br /> �� � � �� u i 7� � s3 /�� <br /> TENANT NAt�1E CONTACT FOR PERMIT PHON <br /> I �.�-�-v'y S"�'� ��3 ��asu <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE p <br /> USE OF BUILDING HEAT SOURCE CONTRAC7 P CE OF WORK <br /> n UJ((�.e�- <br /> �( ���d�����G Eleclric _Gas_Other Q'�D j <br /> --Y 1_ � <br /> Y�ORK D[3CRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM NO. TYPE OF EIXTURE OR ITEM <br /> Toi�et A/C—air handling units <br /> _ Bathtub Forced air systems <br /> _ Levatory(wash basin) Gas piping <br /> Shower Waler heater <br /> _ Kitcfien sink&disposal Gas fireplace <br /> Uishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Water f�eater Range hood <br /> _ Sinl.(service/badmoplelc.) Exhaust fan <br /> _ Backflow prevenler Heal pump <br /> Urinal Unit heater <br /> Orinking;oun4�in Boiler <br /> Floor drain Refrigeralion <br /> _ Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LUCAL SALES TAX CODE IS 1'��5 <br /> I hereby cerili(y Ihat I have raad and ex�mined this application and know the same to be true and correct. All provisions of laws and <br /> ordinacos goveming this type of work will be complied wilh whelher specified herein or not.The grandng of a permil does not presume <br /> to give;.uthoriry to viotato or cancel the provision o(any other state or local law regulating conslruction or the pedormance af <br /> construction.That I am authorized by lhe ewner of this properfy to periorm lhe work for which application is mado and I comply with the <br /> Sta(e�lraclors Law 16.2/RC and 296.200 WAC. <br /> � � �Qo� <br /> Sig Ye o1 Owner! tr ctod thorized Agenl Date <br /> P�, � ,� . <br />