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PL.RMIT APPLICATIGN <br /> CITY OF EVERETT PERMIT SERVICES <br /> / 3200 CEDAR STREET, EVERETT, WA 98201 U <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESSPARCEII TAX I.D. - <br /> LEGA LOT NO BLOCK TRACT �r,` <br /> DESC. �-' W��+ Zu L - U i 1 -03 . <br /> OWNER ADDRESS CITY21 PHONE <br /> ��L�y ll.t^ 1-i (�/�('� 1 cel/ �M 13 A ' ��i 4rar"i O 1115 D <br /> f7.� 1 CR ) k 7 - - <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE A 'i 2 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ~ I j <br /> —Electric XGas—Other <br /> WORK DESCRIPTION <br /> / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE Oi FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) <� Gas piping <br /> Shower i Water heater <br /> Dishwasher <br /> sink 8 disposal Gas fireplace <br /> Disshwawasher Gas range <br /> Clothes washorClothes dryer <br /> Laundry Tray Range hood <br /> Sink(service/bar/moplett.) Exhaust fan <br /> Backfiow preventer Heat pump <br /> _ Urinal Unit heater <br /> Drinking Fountain Boller <br /> Floor drain Rehigerallon <br /> Grease trap _ Woodstove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 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 /> ordinates governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state 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 Contractors Law 18.27 00 WAC. <br /> i <br /> Signature o 45wner! oit actor/ uthonze Agent. a <br />