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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT S�RVICES <br /> 3200 CEDAR STREE'f, EVERETT,WA 98?.01 <br /> 425-257-8810— FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARc ACCEPTED FROM 8 AM TO 4 PM g"�-7 ��� <br /> SITE ADD ESS PARCEL TAX I.D.# PERMIT <br /> ;��aa u c �c�� yo� � `" - <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION M M �� g.�Q 6 <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> /!7/9D�LrJ �5"z��o�t,��9,JEeJ-� `f�� �'J ��5 �x�o`�8 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> E•MAIL <br /> �O-RTFi7C�TU <br /> CONTR.LICENSE p D�jt/// � <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleciric _Gas_Other <br /> WORK DESCRIPTION <br /> � 1��� �Q/LCIL�L�� V <br /> / � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Balhtub _ Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower ✓ Waler heater <br /> Kilchen sink&disposal _ Gas freplace <br /> Dishwasher _ Gasrange <br /> Clolhes washer _ Ciolhes drver <br /> Waler heater _ Range houd <br /> 5ink(servicelbadmop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit healer <br /> _ Drinking Fountain _ 8oiler <br /> Floor drain _ Re(rigera�ion <br /> Grease Irap _, Woodstove <br /> Roof drains _ Other <br /> O�her — <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 cormcL All provisions of laws and <br /> ordinances governing Ihis type ot work will be complied with whether specified herein or nol.The granting of a pertnit does nol presume <br /> lo give authority to violate or cancel the provision of any other slate or local iaw regulating construction or ihe performence ot <br /> construction.,3hat I am aulhorized by the owner of this property to perform the work tor which application is made and I comply with ihe <br /> Slate Cont ��rs Law 18.2 C nd 296 0 WAC. <br /> �- , � � �� rv <br /> Signatu (GwnedCon r ct d thorized Agent Date - <br /> I— <br />