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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 � �,�`p � ' <br /> SITE ADDRESS PARCEL TAX I.D.8 PERM)�# , <br /> r � <br /> i Jo(� lirnn,� W�t• f.-vere:f� ;i,.rA �J8�C,I '� � `�� Z I <br /> IEGA LOT NO. BLOCK TRACT OR SUBDIVISION N i <br /> DESC. <br /> OWNER ND�RESS CITY2IP PHONE <br /> S�t�y.�tt�Ck� lCi�.�, /7/��, G�j+h �!- 1�/ L-.ti,,.��c�5 jso2(� 1O(� -`)4�f- fi�-l� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE � ��,. ��4.s' C•S�'3 <br /> jo���0.��c{ La.Y�� �.C'�.YhinC� �Q�i'tC�- E-MAIL <br /> C..NTRACT R r —ADD SS ITYIZIP PH E <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��ny �n�,� ('rntrr I _Eiectric `�Gas_Olher <br /> WORK DESCRIPTION <br /> (���t- Si�1jm cn ��vo�,t c.f �tl+� h« ��. Id��+`I <br /> J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilel _ AlC-air handling unils <br /> Balhtub __ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer _ Clothes dryer <br /> Waler heater Range hood <br /> Sink(servicelbadmop/etc.) _ Exhausl fan <br /> Backflow prevenb�r _ Heal pump <br /> Urinal ,_ Unit healcr <br /> Drinking Fountain . _ Boiler <br /> Floordrain _, Refric�eration <br /> Grease lrap _ Woodslovo <br /> Roof drains Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerilify that I have read and examined this applicalion anr know the same to be true and correcL All provisions of laws and <br /> ordinaces goveming this rype of work will be complied wiih wheth�. speci(ied herein or noL The granling of a permil does nol presume � <br /> to 9ive authority to violate or cancel lhe provision of any other stale or local law regulating conslrudion or ihe performance of I <br /> construclion.Thal 1 am aulhorized by lhe owner of lhis property lo periorm the work for which application is made and I comply with ihe <br /> Slale Contractors Law 18.27 RCW and 295.200 WNC. I <br /> }«.-i.?.�,� !� �.-/ - vc�' <br /> Signalure o(OwnedContractor/Au:horized Agent Date <br /> `�Z <br />