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� P aMIT APPLICATION <br /> CITY OF EVERETT F'ERMIT SERVICES <br /> 3200 CEDAR STREET, EVEkETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.^ � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDFESS PARCEL TAX I.D.# PER IT# <br /> 3 i i z i s�` '` -t ��i���-�n�� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> L°SC. <br /> OWNER ADDRE�S CITYIZIP PHONE <br /> S;e�•'s 4 N(�n L. �.-f�� Par-fti" SG:p �8.2y Luke �lvc S,�t,��rs�, 3SG-S6fi-Olo7 <br /> TEPJANT NAME CONTACT FOR PERMIT PHCNE <br /> E-MAIL <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> CONTR. LICENSE k <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � �- —P�C X �C S _Eleclric _Gas_Other <br /> `NORK DESCRIPTION �I (� 1 <br /> Repa�r unc(� he���aCe ���� bonrols ON S [ �� r �'✓u�. R�rX �l��er dP��9 �„ <br /> c..l�. ,C+�•� �e�.:�„��� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Dathtub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Watei healer <br /> Kitchen sinY.&dispo:;al _ Gas(ireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> Water heater Ranye hood <br /> Sink (service/badmop/etc.) _ Exhausl fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain _ 8ailer <br /> Floor drain _ Refrigeration <br /> Grease trsp _ 1Noodslove <br /> Roof drains Other <br />�i = a��,�� - <br /> ,, <br /> , <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby certify that I have read ard examined this application and know Ihe same to be irue and correct. All prcvisions of laws and <br /> ^idinances governing this type oi work will be complied with whether specified herein or not.The granting ot a permit does not presume <br /> to yive authority to violate or canccl the provision of any olher slate or local law regulating construction or the periormance of <br /> consiruclion. That I am aulhorized by lhe owner of ihis properly to periorm the work for which application is made and I comply with the <br /> State Contractors Lava 1827 RCW and 296.200 WAC. <br /> �f`��,�� �//�/��J <br /> SignaWre of Owner on�racior/Aitlhonzed Agent a� <br /> l/� <br /> I,� <br />