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RERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �Z �,.���0� <br /> SITE ADDRESS PARCEL T�U(I.D.# PERMIT# <br /> !0 33� I�t bU� S�, �o� o o a S000 !o ��� o Z c� � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION S <br /> DESC. <br /> OWNER � � ADDRESS CITY2IP PHQNE <br /> �/� � C�-e o $o�s. (2ob � N/C(�IZ'�r�K, 4ts��33y��`' <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> E-MAIL <br /> ONTRACT R ADDR S <br /> CONTR.UCENSE# `J W � IL� <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> O� ��� _Electric _Gas_Olher � I� �� <br /> WORK DESCRIPTION <br /> ��1-�- t�� 11s ���� <br /> PLUMBING <br /> MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. 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 Water heater <br /> Kilchen sink�disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust fan <br /> BackOow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Crease trap _ Woodstove <br /> Roof d�ains Other_ <br /> Other — <br /> — _ —I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined lhis application and know the same lo be irue and correcl. All provisions ot laws and <br /> ordinaces governing this type o(work will be complied with whether specified herein or not.The granting uf a permil does not presume <br /> to giva authority to violale or cancel the provis�on of any other state or local law regulatlng construction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work forwhich appiication is made and I comply with the <br /> Stale Contr�rsl�aw-i�, RCW and 296.200 WAC. <br /> _� l �� �2-?�'�� <br /> Signature of OwnedContrectedAuthorized Agent Date <br />