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F�'RMIT APPLICATI�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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ��� {�u�:��, �/ ��C��`i I�1 c e.-+o�-;���e�,3- <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �CL-���= �� �U����,� ��a'C��V� i � �.}C �°`>C'_ �,^�CL� ��i'_��t-1 �����? �`1�������2-Crl:.�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> �4\i �'l�',Y <br /> CONTR. LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric �Gas_.Other <br /> WORK DESCRIPTION <br /> ��'�.-;� C��; ��i'_�f�.; ,� 'Cl7 (U�-�v �Ct�; y�1�Lrj - �� �G���cQw�ew�•-�- a� <br /> C" <br /> ���, I•�c�.. <br /> PLUMBING MECHAfdICAL <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 j� Water heater <br /> Kitchen sink& disposal 7 � 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 <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 1827 RCW and 296.200 WAC. <br /> -����', ���'���, Gi- �`� -U � <br /> Signa ure of O er/Contractor/Authorized Agent ` Date- <br />