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-3 -bfo <br /> P�RMIT APPLICATI(�N � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.c�g <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS � PARCEL TAX I.D.A PERMIT p <br /> �- ( �-�i:>f C�.S, ��J kr,�, �( �: `�o�li3o��, nlyo�� I r�n: � 'V� <br /> LEGA LOTNO. BLOCK TF.ACT <br /> DESC. <br /> OWNER NDORESS CITY/ZIP PHONE <br /> r ✓l,�1rl31ul %� LlC t�(` �r� ,)rtSt . �![i� �,tri N/ �y�, , 3•� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �` !, ilrl�� RSi;J� �1C(�,� 2.Z`! 7U JD <br /> CONTRACTOR ��.�`� ��, t� ���� � . AGDRESS CfTY21P PHONE <br /> / 7� ,, ,_ dr♦l��/� �v«y /Jc,Sc �' J <br /> CONTR.LICENCE p <br /> //V:irTl���JSSRLv 13,•-lli��! GL'9 '%8c•d �y15� `/�'9 -5`�Oc� <br /> USE OF BUILDING ( — HEAT SOURCE ( CONTRACT PRICE OF WORK <br /> Eloctric _Gas_Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITF.M <br /> Toilet A/C–air handling units <br /> Balhtub Forced air sysloms <br /> � Lavatory(wash 6asin) _ Gas piping <br /> Shower . Watnrhealor <br /> Kilchen sinti 8 disposal Gas fireplaco <br /> Dishwaslior Gas range <br /> Clothes washor Clolhes dryor <br /> Wa�er healer Range hood <br /> Sink(service/barlmoplelc.) _ Exhausl fan <br /> Backflow prevanlcr _ Hoat pump <br /> Urinal UNt hoater <br /> Drinking Fountain _ Boiter <br /> Floor drain _ Refrigeration <br /> Groase Irap _ Woodstove <br /> Roof drains Othor <br /> Olhor <br /> CITY UF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby r,oritily Ihat I have read and examined Ihis application and know the samo lo bo lrue and correct. All provision�of laws and <br /> ordinaces goveminc�ihis lype of work will be compliod with whelher specified horein or noL The granting of a permil does nol presume <br /> to givo aulhority to violale or canccl Ihe provision oi any olhar state or local law regulaling wnstruction or Ihe performance of <br /> conslruclion. That I am authorized by lhe owner of this propor'y to paAorm tha work for which applicalion Is made and I wmply with Ihe <br /> State Contrackrs Law 18.27 RCW and 296.200 WAC. <br /> Signature ol OwnadContractodAulhonzed Agent Date <br />