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: �RMIT APPLICA�iuN <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 /> ��i <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �Tl� l�� - <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT# <br /> n � � <br /> /-�. _,_ <br /> ''�v �c i�l�l�j,Z'�� ��Y!�t� `,CJ U`�G�7 -r7 j�� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> <</✓�Vo� ��--(�v% J ��' ,/��'� E-MAIL <br /> CONTRACTOR� ��_` ^„ � ADDRESS CITY/ZIP PHONE <br /> �LfO {-_ �L=-�.:7��� <br /> /���'�' ��� ��/��l`-� /'.i'.�.�t� �����i:L.rCY'l L�i:�.� <f L-�✓ /��'J `�'���� <br /> CONTR. LICENSE# / /`" <br /> ��`i1'�-���� �2-��? �// �%l <br /> USE OF BUILDING ' HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other �`c;J �G�: <br /> I <br /> WORK DESCRIPTION // <br /> � �/ `�✓ �" �r/-`-%�;'L_`-- /ir�'/ ✓ (."t�<��,.�lrl'�l'���; �_ �/Tr'�=�'L�'' / <br /> ��z'/v�Z' <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& 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 FCo`f< <.�>✓�� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinances 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 Contractor��aw 18.27 RCW a 200 WAC. <br /> � � - <br /> �._f, ,�>�� c7 ✓� �.O/i� <br /> Sig ' re:� Owner/ ontractor/Authorized Agent Date <br />