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PEr2MIT APPLICATIO�J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8867—wmni.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> I�t I I -� — "� - �Gq/d �/ <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> TENANT NAME CON7ACT FOR PERMIT PHONE <br /> �lJ_��1i � �� 1'1 Ct � � <br /> CONTRACTOR � AD�RESS CITY2IP HONE <br /> NvZ`�-1W`S � 1'I.,��S��y 3S�� �b6vl^ '�l �.I� �0 <br /> CONTR.LICENSE# <br /> �i )r� i2 iH�r�_�z,C-lCP ��-3 ac� n� T �� _ bo -�S3 ZZ�( <br /> USE OF BUILDING �I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � Toilet A1C—airhandlingunits <br /> Bathtub Forced air systems <br /> 1_ Lavatory(wash basin) Gas piping <br /> Shower �_ Wa:er heater <br /> / Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow preventer I�eat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> / Floor drain Refrigeration <br /> � Grease trap Woodstove <br /> Roof drains Uther <br /> Olher <br /> CITY OF EVERE7T LOCAL SALES TAX CODE IS 3105 <br /> iI hereby ceritify that I have read and examined lhis application and know the same to be true and correct. All provisions of laws and <br /> � ordinaces governing this type of work will be complied with whether specified herein or not.The grarting of a permit does not presume <br /> I to give authority to violate or cancel the provision of any other st2te or local law regulating consWction or the perFormance of <br /> construction. That I am aulhorized by the owner of this property to perforn ihe work(or which applicaticn is made and I comply with the <br /> � State Contre lors Law 18.27 RCW and 296.200 WAC. <br /> � � � �� �� �� �Z� '�� <br /> Signat re of Owner/ContractoUAuthorized Agent Date � <br /> i � ( <br />