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PERMIT APPLICATIUN <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 k <br /> RESS C PARCEL TAX I.D.# PERMIT# /0 <br /> �Lf J � U <br /> 10 <br /> LOT NO. BLOCK TRACT <br /> OWNER ADDRESS CITY2�IP qp PHONE �{� <br /> V-&( g11,C✓Gc. Ir SQ,,y �- �ViirT,l[ a103 y�� lga0-5??7/O <br /> TENANT NAME ( CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> FOu1 i _/-Electric XII Gas_Olhor <br /> WORK DESCRIPTION rNs �4ll Gq <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet AIC—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 dryar <br /> _ Water healer _ Range hood <br /> _ Sink(service/bar/moplett.) Exhaust fan <br /> _ HackOow prevenler Heal pump <br /> _ Urinal Unit healer <br /> Boiler <br /> _ Drinking Fountain Bo <br /> _ Floor drain WoodstRefrigeration <br /> _ Grease trap Other <br /> eve <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*;hether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provisio; of any other slate or local law regulating construcgon 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 /> Slate Con actors Law 1P.27 RCW and 290.200 WAC. <br /> ure o O n nlractorlAuthonz%u gent ate <br />