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P�MIT APPLICATIO��1 <br /> C�TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> � Q0 �� �-� APPLICATIONS ARE ACCEPTC:D FROM 8 AM TO 4 PM � y�.�8 <br /> SITE ADDRESS PARCEL TAX I.D.# PF MIT# <br /> _ � � a�'// '0�/9 I <br /> LEGAL LOT N . BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> 0'NNER ADDRESS CINIZIP PHONE <br /> TENANT NA�AE CONTACT FOR PERMI7 PHONE <br />� I E•MAIL <br /> CONTRACTOR � ^ ` ADDRESS CITY2IP PHONE I <br /> / 1 �J <br /> � CONTR.LICENSE N ��� /� II <br /> I �, <br /> USE OF BUILDING � — HEFT SOURCE ( CONTRACT PRICE OF WORK <br /> Electric _Gas Other <br /> WORK DESCRIPTION <br /> %����;,, ��.� �,.�n� <br /> G'', � �'�� _ <br /> � . 2..� <br /> PLUMBING �� ,'�}- MECHANICAL <br /> NO. TYPE OP FI%TURE OR ITEM1i UNO TYPE OP FIRTURE OR ITEM I <br /> 'foilet A/C –air handling unifs '� <br /> BalhWb f"orced air systems � <br /> Lavalory (wash basin) Gas piping <br /> Shower Watcr heater <br /> Kilchen sink 8 disposal Gas fireplaw <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink (servicelbar/mop/e:c.) Exhaust fan <br /> Backllow preventer ;ieat pump <br /> Urinal Unil healer - <br /> Drinking Founlain �oiler <br /> Floor drain Re(rigeration • . <br /> _ Grease trap Woodstove _ <br /> Roof drains Olher � <br /> Other � <br /> _ I _ I i <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y Ihal I have read and examined lhis application and know Ihe same lo be true and correct All pwvisions of laws and <br /> ordinaces governing this type of work will be cornplied with whether speciiied herein or not.The granling of a permit does not presume <br /> to give authority to violale or cancel Ihe provision o(any o[her slate or Iocal law regulating construction or the per(ormance of <br /> conslruction. That I am aulhorized by Ihe o�vner of this property lo perform Ihe work for which application is made and I comply wilh Ihe <br /> Stale Contractors Law 18.27 RCW and 296.200 WAC. <br /> Signature of OwnedContraclor/Aulhorized Agent Dale <br />