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PERMIT APPLICATION <br /> C17Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-88 i 0— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE AGCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# F�2MITr#' ' / <br /> � ..�(�. � LC�`•_�-}' C�f(-i i iCt C�V Ei , '�- O �1'� S'U�'/T <br /> LEGAL LOT N0. BLC CK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> PJt�r� i�� �'� r Fl!��� , , , (' U : ��r"�� c���C�� EZ>�,f ^.�O-��Cl ��JF . c"er�e_.t-f, Gc��.v � <br /> �IZ�- 2'_;L _1`__, I � <br /> TENANT NAME CONTACT FOR PERMIT PHONE�17��_�`j j- ��j I� <br /> IOL�r � � C�r � �r�j �rre��y IGG�% ��QI�Go.C' M <br /> E•MAIL- <br /> �ONTRACTOR ADDRESS CITY/ZIP PHONF <br /> CONTR.LICENSE# --�- I F <br /> USE OF BUILDING HEAT SOURCE �.ONTRACT PRICE OF WORK <br /> Eleclric Gas Olher <br /> WORK DESCRIPTION �-. � � -,� �_,�rl :St!_�C t � '- � C: <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NU. TYPE OF FIXTURE OR ITEM <br /> To; t A/C—air handling unils <br /> — g������� Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower W ater heater <br /> x Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Cbthes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink (servicelbar/m�p/etc.) _ Exhaust fan <br /> Back(low preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Re(rigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ Other _ <br /> = Olher =I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify lhat I have read and examined this applicalion and know the sam,tu be Uue and correcL All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting oi a permit does nol presume <br /> to give autbriry to violale or cancel the provision of any olher slate or local law regulatinc�wnstruction or Ihe performance of <br /> conslruclion.Thal i am aulhorized by the owner o(lhis property to perform lhe work for which application is made and I comply with the <br /> Stale Contraclors Law 18.27 RCW and 296.200 WAC. <br /> � � � <br /> �2/.-='-�- - � ,F/i:� . �� J -/'� �O <br /> SignaWre of OwnedConlractor/Authorized Ac�enl Date <br />