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I f <br /> PERMIT APPLICATIUN <br /> CITY OF EVERETT PERAAIT SERVIC�=S <br /> 3200 CEDAR STREET, EVEREIZ,WA 98201 <br /> 425-257-8810— FAX 425-257-885'i—wwov.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM J� �—O� <br /> SITE ADDRESS f=.4RCEL TAX I.D.# PERMIT# <br /> � <�33� ��( � �£ S � ��d� m a ��-aoZ <br /> LEGAL LOT NO. BLOCK TRACT pR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �,�'1 � � � � Po B �� I'���� ,�1�cc cnF�n �,1� ��3� 4 y <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> TRA T R A � <br /> CONTR.LICENSE# C �N �^ I` <br /> USE OFBUILDING I HEAT SOURCE CONTRACT PRICE OF WORK � <br /> U �— � I �'C _Electric �Gas_Other � � �U� ' �" <br /> WORK DESCRIPTION <br /> p�c �c-i l��n �c <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br /> Toilet _� A/C—air handling units <br /> Bathtub A Forced air systems <br /> Lavatory(wash basin) _ G�s piping <br /> Shower _ Waterheater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> � Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Founlain ___ Boiler <br /> Floor drain Reirigeration <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerilify lhat I have iead and examined lhis appiicalion and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whelher specified herein or not.The granting of a permit does not presume <br /> lo give aulhoriry lo violate or cancel the provision of any olher state or local law regulating constructinn or lhe performance of <br /> conslruclion.That I am aulhori ed by the owner of this properly lo perform the work for which applicalion is made and I wmply with lhe <br /> Stale Contractors law 18. �nd 296.200 WAC. <br /> c_.—:' ��.. /-?-�� <br /> - ; — <br /> -Signeture o��dConlractor/Authonzed Agent Date <br />