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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8b57-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.�{ P F�M�T� � <br /> 2��� �� �� � i <br /> LEGA LOTNO. BLOCK TRACT C <br /> DESC. �3�/ / -�aa -oz3 - o �o ; <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANTNAME CONTACTFORPERMR �'vis�cas�ig <br /> SA1�NeS woo0 i r.1 � C P�I �i�l�s5 �Go -�S6•or VS <br /> CONTRACTOR ADDRES CIT�V�r�P� � PHONE <br /> $141�C� CRd9t?O 1 n.�G /ObS 13M/tisf�4 /�'e� /h/�yfu/f!f �p.i$'8-61�5 <br /> rv/�1 <br /> CONTR.LICENSE N <br /> �4�N6wIOS�OQ <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> (���,Ib'T Y1tiF(e _Electric _Gas_Other ��b�Qt70 y <br /> WORK DESCRIPTION <br /> �� 0�4 sr,�.� s� �� N� a�� <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM NO. TYPE OF FUCTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal _ Gas flreplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry trey Range hood <br /> Sink(servicelbarlmop/elc.) Exhaust fan <br /> Backtlow prevenler _ Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Retrigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Other _ Spf2S�p 8� GcVT! T/PA� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this appiicatlon and know the same to be true and cortect. All provisians of laws and <br /> ordinaces goveming this rype of work will be complied with whether specified herein or not.The grantlng of a pertnit does not presume <br /> to give aulhority to violate or cancel the provision af any olher state or local law reguladng construc8on or lhe perfortnance of <br /> construcfion.That I am authorized by the owner of this property to peAorm the work for which applicatlon Is made and 1 comply with the <br /> State Contractors Law 18.27 RCW and 296200 WAC. <br /> Signature of �1nedContreclodAutharized Agent Date <br />