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PERMIT 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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> i iDIN � NrFI v s = � /$ o -oo� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# I <br /> DESC. i <br /> OWNER ADDRESS CITY/ZIP PHONE �', <br /> C o � STA � SFn r� o� <br /> TENANT NAME CONTACT FOR PERMIT PHONE , <br /> �U N U �� I �N N �Nr� I E-MAIL <br /> T TOR f ADDRES � <br /> CONTR.LICENSE# �O�V t S r C l ' Q� �J ������u ms � n( <br /> L <br /> V� <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WbRK <br /> Electric _Gas_Other <br /> WORK DESCRIPTION <br /> �/j�� � �fl�'"O /G� <br /> PLUMBiNG MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Balhtub Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> j,�_ Clothes washec . ,� Clothes dryer <br /> b'Vater heater Range hood <br /> y�C Sink (service/bar/mop/etc.) _ Exhaust fan <br /> Backtlow preventer _ Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> � Floor drain _ Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> ! Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby certify�hat I have read and examined this application and know the same to be irue and corred. All provisions ot laws and <br /> ordinances governing this�ype of work will be complied with whether specified herein or not. The granting o(a pertnit dces not presume <br /> to give authority to ' ate or c cel the provision of any other state or local law regulating consiruc�ion or the perfortnance of <br /> construclion.T at `u zed by lhe owner of lhis property to perform tYe work for which application is made and I comply with the <br /> Stale Contra r a ; RCW and 296.200 WAC. <br /> ., �-� i� <br /> Signature o Ow er � act "Authorized Agent Date <br /> i <br />