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P�RMIT APPLICATIG�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32''� CEDAR STREET, EVERETT, WA 98201 <br /> 4^5-?57-8810– FAX 425-257-9857–www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � _!� � <br /> SITE AUDRESS � �.�ti PARCEL TAl(I.D.# PERMIT# <br /> LU � � � 1 ' �� S� f�l� /�- n r�.�- <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> (1 � ��tc-�i-qs2 �-�kc:�,� <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> CO�iTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# �„ C, ' D � q� � <br /> v l.i�'\r�J1Nl _-Vl"J <br /> USE OF BUILpING ` HEAT SOURCE CQNTRACT PRICE OF WORK <br /> — — — r V <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> �) e"l'� 1 �' ���— <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower Waterhealer <br /> _ Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer � <br /> Waler heater Ran�e hood <br /> Sink(service/badmop/etc.) Exhausl fan <br /> BackFlow preventer Heat pump <br /> Urnal Unit heater <br /> Drinking Founlain Boiler <br /> _ Floor drain Refrigeration � <br /> _ Grease trap Woodstove � <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LQCAL SALES TAX CODE IS 3105 <br /> t hereby ceriti(y that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does i rol presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating censtruction or lhe performance of <br /> construction.That I am autho-�zed by the owner of this property to perform the work tor which applicalion ie made and I comply with the <br /> Slate Contractors Law 18.27 RCW and 296.200 WAC. <br /> /�l(� <br /> SignaWre of 0 er onlractor/Authorized Agent Dale <br /> l( <br />