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PERMIT APPLICATIO <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 /> C <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM EaPi-6161� <br /> SITEA DRESS PARCEL TAX I.D.# ZRIAIT# <br /> Z� no/a /4p0 '7/4i '0 00 '& 2 � -x7 7 <br /> LEGAL EOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER // ADDRESS CITY/ZIP PHONE <br /> Scots /o %7 /41 //ve .Gra 93205 405 Yyfl /5�.5 <br /> TENANT NAME CONT54CT FOR PERMIT PHONE <br /> (.5: L- E-MAIL 52C246615/1-7-071 <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> f ltfG re _Electric I/ Gas_Other <br /> WO17ESC T / <br /> e.,,e_ _ 44..) 5e4a e4.,,,/id <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 7 Toilet A/C—air handling units <br /> 2 Bathtub Forced air systems <br /> 1 X Lavatory(wash basin) ,TGas piping <br /> / Shower Water heater <br /> / Kitchen sink&disposal 1 Gas fireplace <br /> ► Dishwasher Gas range <br /> / Clothes washer Clothes dryer <br /> -=4 " Water heater A Range hood <br /> / Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain / Boiler <br /> 1 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. at I am author'.'-d by the owner of this property to perform the work for which application is made and I comply with the <br /> State Cont./ ors Law 18,2'1 "CW and 296.200 WAC. y <br /> �'L f /44 <br /> ig ature Orr ner/Contractor/Authorized Agent Date l <br />