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PERMIT A�PLICATIOI� <br /> ClTY OF EVERETT PERM17 SERVIC�S <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 Cf � aO —� <br /> SITE AD�JRES� / ��� PARCEL TAX I.D.# PERMIT# <br /> _� <br /> LEGAL L0T NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS C�TYIZIP PHONE <br /> � �� � s � <br /> Ou 5 4 L`/' UC'' <br /> TENANT NAME CONTACT FOR PERMIT PHOkE <br /> �� � � �I�'.• E-MAIL <br /> CONTRACTO�j^ � /} ADDRE S � TYf IP HONE <br /> l>�//��� L G�S� �rc �"/US �/"ea�r✓o� �J. ��3 y.1S -3S�SSUU <br /> CON?R.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ev <br /> �e.�a,� _Eleciric _Gas__Other L��GGGi <br /> � <br /> WORKDESCRIPTION / ' �' *� IP <br /> � c�. .,�� <br /> a ,v�� �s�;� ��o,��J 4�� � �._.:�.�.� ,��� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTl1RE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhtub Forced air systems <br /> Lavatory (wash basin) Gas piping <br /> Shower W ater heater <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water heater Rango hood <br /> Sink(service/badmop/etc.) _ Exhaust(an <br /> 6ackflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Re(rigeration <br /> Grease trap _ Wcodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I her�by ceriti(y ihat I have read and examined this application and kno�v the same lo be lrue and correct. All provisions of laws and <br /> ordinaces goveming this lype o(work will be complied wilh whelher specified herein or noL?he granting of a permit does not presume <br /> to c�ive authority lo violate or cancel the provision of any olher stale or local law regulating construclion or the performance o( <br /> construction.That I am aulhorized by the owner of this property to peAorm lhe work tor which application is made and I comply with the <br /> Stat�Contraclors Law 18.27 RCW and 296.200 WAC. <br /> ��� � �/� ��.=',.�. '��'���—�/ <br /> Si�nalur o�Owne�JConlraclor/AulhorizedAgent Dale <br /> ✓ f � - ��Z <br />