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PtRMI�' APPLICATIGnI <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org �� —7 —fl� <br /> APPLICATIC�NS ARE ACCEPTED FROM 8 AM TO 4 PM � �1 "��Q-D0� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT p <br /> -�,o� l�-���� ��e.. -Ba�� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION It <br /> f1ESC. <br /> OWNER �� ADDRESS CITY2IP PHONE <br /> I7�C � ��C�1 �n✓ti.5�"n�Pn�" ��i ��'r��"ISr�S � LLL Evpvef{- Lc�PI 91s����G7G <br /> TENANT NAA7E I CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> TRAC R ,\��✓' �JfJ'.'1'd: Y i� A P <br /> V <br /> / <br /> CONTR.UCENSE p <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _ElecUic �Gas_Othor <br /> WORK DESCRIPTION <br /> �7� �'�Y1�0�'i5 <br /> PLUMBING MECHANICAL � <br /> N0. TYPE OF�IXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel _ A/C–air handling units <br /> Balhtub Forced air systems <br /> �_ Lavatory pvash basin) Gas piping <br /> Shower Waler healer <br /> Kitchen sink 8 disposal Gas firepla:o <br /> Dishwashcr Gas range <br /> Clolhes washcr Clothes dryer <br /> _ Water healer Range hood <br />_ Sink(serviceNadmop/etcJ � Exhaust(an <br /> Backllow preventer _ Heat pump <br /> � Urinal Unit heater <br /> Drinkinc� Foun7ain Boiler <br /> Floor drain Refrigeretion <br /> Grease lrap Woodstove <br /> Roof drains Olher <br /> — o�r,er — �— <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS 9105 <br /> I hereby ceritify that I have read and examined Ihis applicalion and know tho same to be true and correcL All provis�ons of laws and <br /> ordinaces�overning Ihis lype of work will be complied��vith whelher s�ecified herein or noL The granting ot a permit ioes not presume <br /> to 9ive authority to violate or cancel the provision of any olher stale or local law regulating conslruclion or th�;.•��rtoi,nance of <br /> construclion.'L-at I am authorized by Ihe owner ol this property to perform the work for which application is made and I wmply with the <br /> St�Coptractors L�w`18.27 RCW a d 29�.200 WAC. <br /> �,v--1, � � �� l. IU Z (?; <br /> Sign2lure of OwnedContraclodAulhonzed ent Da e I <br /> J <br />