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FcRMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, Evr=RETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS _ PARCEL TAX I.D.# PERMIT# <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER .� ADDRESS CITY/ZW'/'0 PHONE <br /> '{(7y/,/�� 5-+- ivi.,��(�/zv: `1z ' �y�'- 7r5�� - <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTQR CITYMIP PHONE <br /> CONTR.LICENSE N q z <br /> ti�ntiz�z �,t> " <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �J77P S _Electric )4 Gas Other I � 3e( <br /> WORK DESCRIPTION <br /> VO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> _ Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3103 <br /> 1 hereby ceritify that I have read and examined this application and know the same to be true and correct. All provlslons of laws and <br /> ordinates governing this type of work will be compiled with whether specified heroin or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other slate or local law regulating construction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Cpg(ractors Low J8,27 R�W-an 208.200 WAC. <br /> n 7 <br /> S nattlreo a tractor/ uthorizedTganl Date <br />