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PCRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I Z- i 2 "�S <br /> SITE A���S � �� � �A�CEL TAX I.D.# �/1 /'D �05/IT# <br /> U'7 � � �- °� `� _ <br /> DESCL l `f I'7O �y- � � CK T �T I�p Zf"�M-+'CV J—G� �VCQ/lJJ' <br /> � J <br /> OWNER (\'�� � 1(�.Q/� ADDRESS CITY2IP PHONF <br /> �S�'�Q/ ��of-� � � l�� � C 1 C � r�}�' ���'—.�C�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> U �� P N�--- Y11 � � C.� �2-�S S ��� <br /> CONTRACTOR AD�RESS CIN21P PHONE <br /> CONTR.LICENSE# ��, � <br /> USE OF BUILDING � � HEAT SOURCE CONTRACT PRICE OF WORK <br /> �£� �/ �Electric _Gas_Olher <br /> WORK DESCRIPTION � ' /� �� ����� � n � n� 1 <br /> T�w� o �-- �x �� I c T <br /> J--� I � 1 ' �S �I� � I �� �� �� MECHANICAL <br /> PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet fVC—air handling unils <br /> Bathlub Fomed air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> CbUies washer Clolhes dryer <br /> Water healer Range hood <br /> Sink(serviceNadmop/etc.) Exhausl(an <br /> Back(low preventer Heal pump <br /> Urinal Unil heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> _ Grease lrap Woodslove ��� <br /> Roof drains Other <br /> Olher <br /> I — <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined this applicalion and know lhe same lo be true and correct All provisions o(laws and <br /> ordinaces�overninc�this type of work will be complied�vith whelher specilied herein or noL Tho granting of a permil does not presume <br /> lo give authorily lo violate or cancel the provision of any other stale or local law regulating construclion or the peAormance of <br /> conslruction.Thal I am aulhorized by the owner of lhis property to perform the work for which applicati�made and I comply wilh the <br /> State Conlraclors Law 18.27 RCW and 296.2 WAC. <br /> � fL� � J� 1 � 2- � � �� <br /> Siyna e of OwnedConiractor r. ate <br /> •� ,. <br />