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� ^ <br /> P�RMIT APPLICATION <br /> CITY OF EVERETT I'ERMIT SERVICES <br /> 3200 C�DAR STREET, EVERETT, WA 98201 <br /> 425-257-88'0- FAX 425-257-8857-www.everettwa.org <br /> APPLICATION3 ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL?AX I.D.� PERMIT# <br /> �da,s- � �,�-e S�= � � ����o �_ � <br /> LEGA LOTNO. BLOCK 'TRACT — <br /> DESC. <br /> OWNER ADDRESS CITlIZIP FHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ,Sa/v� �oc� �'o���� <br /> CONTRACTOR � �nl e" IUm� , 1`_ ADDRESSL _13�•1P�1TM/ZIP PHONE <br /> -f� �, P d ► N3o I N� � ���a.� ,��:1� <br /> CONTR.LICENSE# � /� <br /> �ll��� _ <br /> USE OF BUILDING I / HEAT SOURCE I CONTRACT PRICE OF WORK <br /> / <br /> Co F ��. s�.o,� ��Eleclric Gas Other <br /> WORK DESCRIPTION <br /> ��u '"�'� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> . Toilet A/C—air handling units <br /> thtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> ower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> lhes washer Clothes dryar <br /> � er heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> nking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap � Woodstove <br /> Roof drains Olher <br /> � Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces governing lliis type of work will be complied wilh whether specified herein or not.The granling of a permit does not presume <br /> to c�ive authority to violate or cancel the provision of any other state or local law regulating wnstruction or the performance of <br /> conslruction.That I am authorized by the owner ot this property lo perform lhe work for which application is made and I comply with the <br /> State Contrectors Law 18.27 RCW and 296.200 WAC. <br /> Signalure of UwnedContractor/Authorized Agent Date <br />