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P�RMIT A►PPLICATION � � � � �`- °'� <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 S—�f�d 9 <br /> SITE AD�D/RESS PARCEL TAX I.D.# PE�RMIT# <br /> 1jC1� '7 ���r/ S� C /v_/•nS Uly <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS C!TYIZIP PHONE <br /> C� S�,+ � Se �2N��- _ <br /> TENAkT NAME CONTACT FOR PERMIT PHONE <br /> E-MPJL <br /> CONTRpCTp�Q(��fCl� � [�c,��Uircr A�DRESS ITYIZIP 0 E I <br /> �y ��v ,�LY�� ry,��,.�r��� �i�r- �s-v—y�icy <br /> CONTR.LICENSE q Z 73�� Cj�—Z.Z� <br /> 2��;,,��:� 2�zC � ` - <br /> USE OF BISILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Flectric _Gas_Other � � Z(j�d <br /> WORK DESCRIPTION � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Z Toilel A/C—air handling uniL•; <br /> Bathlub Forced air syslems <br /> —� Lavatory(wash basin) Gas piping <br /> Shower �_ Waterhealer <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Waler heater Range hood <br /> Sink(service/badmop/elc.) _ Exhaust fan <br /> Backflow preventer _ Heal pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drein Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Olher _ — <br />� CITY OF EVERE�i LOCAL SALES TAJ(CODE IS 3105 <br /> I hereby ceriti(y thal I have read and examined this application and know the same to be true and correct. All provisions oi laws and <br /> ordinaces yoverning lhis type o(work will L'e complied with whelher specified herein or not.The granting of a permit does not presume <br /> to give aulhorily to violale or cancel lhe provision of an��other slale or local law regulaling construclion or lhe performance of <br /> construction. That I am aulhorized by the owner o(this property lo perform the work for which application is made and I comply with the <br /> Slate Conlractors Law 18.27 f3GW and 296.200 WAC. <br /> ✓ <br /> 11�����;.;,� ,�c s' n ��, <br /> Si na ure o(OwnedContractor/Aulhonzed Agent Date <br />