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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.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# �RMIT# – �� <br /> � �� 0 L SM��F4 S� OG 3 O 7 � G 1. IG G �� <br /> LEGAI LOTNO. BLOCH TRACT <br /> DESC. <br /> OWNER AUDRESS CITYIZIP PHONE <br /> FO�,✓Lcr d it..� (cS (� bcR 2� �Vc✓c�-( 1v� i�lZc � _ <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> � � c � f� r' • � c 5f��� 1'��.,., �, yzs- »G -Sa 3_s <br /> ti <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> /jarr�r Nt�.v � c �y��, h/9.-�:s<�v �n 2 77� -S`$' 33� <br /> Y s= <br /> CONTR.LICENSEp ��i ���ti. �` ��c a, £.Vt:��-l�� l./{- 5S� Zi S <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> C4r��r{ S _Electnc _Gas_Other $ 2� L�/o. <br /> C�� <br /> WORK DESCRIPTION �`�.�.}-c c �'3 ) v S�-<<� 5�yv c 9 5�:+�•F 5 <br /> PLUMBING MECHANICAL , <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet _ NC–air handling units <br /> Balhlub _ Forced air syslems <br /> Lavatory(wash basm) _ Gas piping <br /> Shower __ Water heater <br /> Kdchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/barlmop/elc.) _ Exhausl fan <br /> Backtlow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> �rinking Foun�am _ Boiler <br /> Floordrain _ ReFngeration <br /> Grease trap _ Woodstove � <br /> Roof drains _ Other <br /> Other — — <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 5105 <br /> I hereby centdy Ihat I have read and examined this appGcation and know lhe same to be true 2ntl correcl All previsions ol laws anA <br /> � ordinaces goveming this rype of work will be complied wdh whelher speci(ied herein or not The granting of a permit does not presume <br /> I to give authonty to violate or cancel the provismn of any olher state or local law regulating construc6on or the peAormance of <br /> � mnstruction. Thal I am authorized by the owner of this property to perform the work for which appliwtion is made and I comply•.vith ihe <br /> State Contractors Law't�27 R�W�'��� _ ?AF'�AL' .. . �� ,._. ; <br /> � �� � � ) <br /> I Signat ol Ow�irac OAuthorize��eng t �a� 1/L <br /> i-- - - - <br />