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PtRMIT APPLICATIOnI <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 /> � c a9 C � �� t�^ [� �:� - <br /> LEGA LOT NO. BI.00K TRACT <br /> DESC. <br /> OWNER ADDRES:. CITY2IP PHONE �¢��t— ��� 7� <br /> Jr.l.f �Dl�t /.����j � � /(o.��� 5—T Lvo-ozl��v.%l,p � <br /> TENANTNAME CONTACTFORPERMIT PNONE <br /> 1�a�� .� or.sP� I �in'- r��i- 37� <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Olher <br /> WORK DESCRIPTION <br /> -�— f.[ r!�R c.Q � �lG� > � c�.Gc <br /> / <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilek A/C—air handlinfl units <br /> _ Ba:htub �/ Forcedalrsystems <br /> Lavatory(wash basin) Gas piping <br /> Shower Wale�heatar <br /> Kitchen sink&disposai Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> 8ackflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> Grease lrap Woodstove <br /> Roof drains __ Other <br /> Other <br /> CITY OF EVERETI�LOCAL SALES TlJC CODE IS 3105 <br /> I hereby ceritl(y that I have read and examined lhis applicalion and know the same to be lrue and corcect. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether spocified herein or not.The granting of a permil does not presume <br /> to give aulhority to violate or cancel the provision of any other state or local law regulatlng construction or the pedormance of <br /> construction.That I am authorized by the owner of this propeRy to perform the work for which application is made and I comply with the <br /> State Contrectors Law 18 27 RCW and 296.200 WAC. <br /> ___� � _ � , � �/ / jJ� <br /> Signature of• � eY o�rectod thonzed Agen Date <br /> \( � <br />