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- - - -- -- --� --- ------- --- <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -wvnv.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br /> SITE AODRESS pARCEL TAX I.D.N PERMIT M <br /> / ��S /b.dre?2 Si3�c��T� �07 �� -O ��l <br /> IEGF�_ LOTNO BLOCN TRACT ' <br /> DESC I <br /> OWNEH ADORESS CITVIZIP PMONE <br /> q JFl �/2 L N i t:=J=/Je' �S c�.S <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR �����5��� �jL�,n��N� AD�RESS CITV/ZIP PHONE <br /> CONTR. LICENSE� ` �g z�33� /LYi���/e' /�/1L-/i.J(�n�., ,36�' � �f05 �vt j� <br /> �� /N(�RZ7LCy <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> `5 F� I _Electnc _Gas_Other .3 U��� �� <br /> WORK DESCRIPTION <br /> /� SiALL F �i?L S/-'/?iNK�L'yZ / N NC=7✓ SF/�, <br /> PLUMBING MECHANICAL <br /> HO. TYPE OF FIX7URE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ To�iet AiC -a�r handi�ng un�ts <br /> .__ Batntun Forced au systems <br /> _ Lavatory�wash bas�n� Gas piping <br /> _ Showe� Watei heater <br /> _ Kitchen s�nk 8 d�spesal Gas lueplace <br /> _ D�shwashe� Gas renge <br /> _ Ciotnes wasner Cloines aryer <br /> ___ Laundry tray Range hootl <br /> ._ S�nk �serv�ce�barnnop�etc � E•haust fan <br /> ._ OackAow preoenter Heat Oump <br /> _._ Unnal Und heater <br /> Drinking FounWm Boiler <br /> .__ Floor ara�n Reinge �hon <br /> _ Grease trap Woodstove <br /> __ Roof are�ns Other <br /> i Otner — <br /> --I [�¢ s/�a��r �t�iz i+e-.fJS <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> � nereby centJy tnat I have reatl ana e�arrdned this ap0licahon antl know the same to be true and correct All prow9on5 ot laws an, <br /> �,�� naces goierrong tnis tyCe W worN w�il be complied w�tn wr�ether specihe0 herein or nol The granung of a perm�t tloes not presume <br /> �c �:.e a�.ithonty tu v�oiate c� [3n�_el!hc p�ovi5ion ol Bny Olher 5�01C or loCal laW reyuldting ConSlNt�iOn ur thE p0rtormdnCB 0� <br /> :cnsiruCt�on That I �nt aut%.nzed by ihe owner of Ihis p�operty lo perform(he work for which applicB6on is matle and I Comply wdh Ine <br /> 3'ate Comractors La��ro iB 27�✓ano 296 200 WAC <br /> 5�na we ol ,sr ei�C^tr ctonAuthorize0 Agen( ��4 - l/� <br /> Cfet <br /> _ - - <br /> — - - ----- -------.. --- - --- <br /> ��a <br />