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PEKMIT APPLICATION <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 /> ------------------------ <br /> PARCEL TAX I.D.p P�RMIT 0 / <br /> SITE ADDRESS <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. CITY2IP PHONE <br /> OWNER ADDRESS <br /> )V^ W �e�eluw �aa� I�cr Si Sc k� efc � wW 3g7-36s5 <br /> TENANT NAME <br /> CONTACT FOR PERMIT PHONE <br /> 1 <br /> S 1 ame 7S c. � \1 e 5C., V--e 4 5. G too V � <br /> CONTRACTOR <br /> ADDRESS CITY2IP PHONE <br /> ) <br /> CONTR.LICENSE fr <br /> USE OF BUILDING <br /> HEAT SOURCE CONTRACT PRICE OF WORK <br /> ry _Electric _Gas_Other <br /> WORK DESCRIPTION II 1 �JA <br /> C ✓ <br /> PLUMBING MECHANICAL <br /> NO. <br /> TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ AIC -air handling units <br /> _ Toilet Forced air systems <br /> _ Bathtub Gas piping <br /> _ Lavatory(wash basin) Water healer <br /> _ Shower Gas fireplace <br /> _ Kitchen sink 8 disposal Gas range <br /> _ Dishwasher Clothes dryer <br /> _ Clothes washer Range Mod <br /> _ Water heater Exhaust fan <br /> _ Sink(service/bar/mop/etc.) Heal pump <br /> _ Backflow preventor _ Unit heater <br /> _ Urinal Boiler <br /> _ Drinking Fountain Refrigeration <br /> Floor drain Woodstove <br /> Grease trap Other--L,4 r D tiJy <br /> _ Roof drains <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ified <br /> roin or not.The <br /> tordinaces governing this o give authority to violate or cancel e of r he iprovis on oll be il any otheled with rrstate or lether ocal law regulating egu ating construct oln oring <br /> he performance o1 t does not presume <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 /> Slate Contractors Law 18.2777RRRCCW Wa`n`d 2,966.220000 WAC. / <br /> Sv re of Own�onlractorl uthonzed gent <br />