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I'�RMIT APPLICATII�I <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 /> NS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS ' `"' PARCEL TAX I.D.# PERMIT# <br /> �o�� l�v. ,��5 ' <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> ��/�6 <br /> TENANT NAME C NTACT FOR PERMIT PHONE <br /> � �'��^�` ��-��,�,s,�� �i.s �7�- 2s-q � <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> Ca�-���.��— <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �'112�G���� ��-� , _Electric _Gas_Other �2� p-�i-� <br /> WORK DESCRIPTION <br /> ,�,�� G``A.'GG.f <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 T Clothes dryer . <br /> Laundry tray 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 compiied 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 ontractors Law 18.27 RCW and 6200 WAC. <br /> l/ 2� 0;1'" <br /> i <br /> Signature of Own /Contractor/Authorized Agent Date �� <br /> !� <br />