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i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE"I T, 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 /> �� ��"' l-5� `J��P� /Y/D -�G� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �,(�!!"/�j / K°/1C`lE:� 7i7�� .�� �V ��.� Tir^�J^/L9[7 <br /> TENANT NAME I CONTACT FOR P RMIT PHONE ZS� <br /> ��� ��ev E-MAIL <br /> A R IZI P . Z � Z� <br /> N��f�/'S �'rH�� �r�� �ze� N�=����`/�/ �./�J�/ /�q. p� <br /> CONTR.LICFNSE# ���E���/�� /�//7Cl� 70f/�� <br /> USE OF BUILpDING HEAT SOURCE CONTkACT PRICE OF WORK <br /> — /7 /�-- ✓Eleclric _Gas_Other � �Z•� <br /> WORK DESCRIPTION �� � ,yyy�-�A� �,v���, �/�tri� rr�� <br /> � � <br /> PLUMBING MECkANICAL <br /> I.ip, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Batntub _ Forced air systems <br /> Lavatory(wash 6asin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas firepiace <br /> Dishwaaher _ Gasrange <br /> C�othes washer _ Clothes dryer <br /> Water heater _ Range hood <br /> Sink (service/bar/moplelcJ _ Exhaust fan <br /> Backflow preventer _ Heal pump <br /> Urinal _ Unit heater <br /> _ Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Wondstovr <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby certify that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied wilh whether specified herein or not.The granling of a permit does nol presume <br /> to give authorily to violate or cancel ihe provision of any other state or local law regulating construction or ihe performance of <br /> conslr hal I am authorized by ihe o r of this property to perform the work for which applicalion is made and I comply with the <br /> Stat Contractor Law 18.27 d 29 200 WAC. /G'�' 'n� <br /> t > C�Y <br /> Sign , of OwnedC niract Au o zed Ag2nt Date <br /> I <br />