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PERMIT APPLICATIC�N <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 /> �� �:�\ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ��. <br /> ��r �. , ��c�n�oc�R Oo3q3�-a�o -�3 -oo � ��" �� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. ��I �jA'�-( li l�t.J �T� <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> N �c�-�r�S s�+�P�f�►2D <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> �V�kLK�.2 C��N57�tLT��onJ �2l STH-T�- �ll� ST�, g rn�4�5VYr� �Sa-7o <br /> CONTR. LICENSE# �,�J f}L{�E���l�� 3(cD -�nS'S'OS�O <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> or� <br /> S�� �Electric _Gas_Other � �sjd�d • <br /> WORK DESCRIPTION <br /> .�"N S J�4C_L � /�1 E[�.� YI'I H�Nc.-Q%f4G'TU�'�� �r��'N E <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 '���.�.a,�s ,�t-�• '�1�,., �. .� ; � , <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 /> ordinaces 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 RCW and 296.200 WAC. <br /> �� -,= e - — //-�3 z�q <br /> Signature of Owner/Contractor/Authorized Agent Date , <br /> ��'�_. <br />