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I <br /> PERMIT APPLICATION <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 '� � a I`IO <br /> SITE ADDRES PARCEL TAX I.D.M PERMIT p <br /> Zq So �..r�ce� �. IGo'1 - a-c� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION 8 <br /> DESC. <br /> OWNER � ADDRESS CITYIZIP PHONE <br /> �tleX�-�, � �c-t--}� 29'.,o Rixkk,fZ A� `Ifl'wl 252-3��f1 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> h�Rtt 1JG...u��n'r� <br /> Z�'j–C�I E•MAIL <br /> I <br /> CONTR.LICENSE# --y /„�/�� ��� <br /> / X-� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other <br /> WORK DESCRIPTION <br /> Se� �'�-� ��d�u�-- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE GR ITEM N0. TYPE OF FIXTURE OR ITEM — <br /> Toiiet _ NC–air handling unils <br /> Balhtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> i<ilchen sink&disposal _ Gas firep�ace <br /> Dishwasher _ Gas range <br /> Ciolhes washer _ Clolhes dryer <br /> Water heater _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhausl fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ o�her <br /> Other — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certi(y that I have read and exami„�d fhis application and know the same ta be true and corcect. All provisions of laws and <br /> ordinances goveming this type oi work�',,il be camplied with whether specified herein or not The granting ot a pertnil does not presume <br /> to give authority to violate or cancel lhe provis�un oi any other state or local law regulating consWction or the performance of <br /> construction.That 1 am authorized by the owner of Ihis property to periorm ihe work for which application is made and I comply with ihe <br /> State Contractors Law 1827 RCW and 296.:L'O WAC. <br /> SignaNre of OwnedConiractorlAuthorized Agent Date �/i� <br /> �� <br />