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P�RMIT APPLICATIOrI <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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � <br /> � ; I� �—�;�C �� �'��, G6 0 - <br /> ..EGA LOT NO. BL K TRACT <br /> DESC. <br /> aWNF ADDRESS C�TY21P P ONE �� <br /> R G�t�� 3b0-b59- <br /> ���1 � ��[} �-` 1�.; < <�cl � I)�����' j� N� (�^�ov�lu' 9323 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �os �c�os " J��c�, C,;��2 �-12s - z�z - �� �i3 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING \ / HEAT SOURCE I CONTRACT PRICE OF WORK <br /> J,l,`�r, c J��l� I / `Eleclric _Gas_Other <br /> 1 <br /> WORK DESCRIPTION <br /> � � �51�Z��S <br /> �C� (�l�,ll�._�,a�1C,� L1�OC�C_ '�<11 <br /> J <br /> PLUMBING MFCHANICAL <br /> NO. iYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ AIC—airhandlingunits <br /> Bathtub _ Forced air syslems <br /> Lavatory(wash basii:) _ Gas pipinc� <br /> Shower _ Walerhealer <br /> Kitchen sink R disposal _ Gas fireplace <br /> Oishwasher _ Gas range <br /> Clothes washer Clothes dryer <br /> Water healcr _ Range hood <br /> _� Sink(service/badmopletc.) �, j _ Exhausl fan <br /> Back(low prevenler _ Heal pump <br /> Urinal _ Unil hoater <br /> Drinkinc� Fountain _ 8oiler <br /> Floordrain _ Refrigeralien <br /> '�_ Grease lrap jt � _ Woodslove <br /> Roo(drains — ���1°� <br /> Olher — - <br /> CITY OF EVERETT LOCAL SALES TA7(CODE IS 7105 <br /> I hereby ceritily thal I have read and examined this application and know the same to be true and correcL All provisions of laws and <br /> ordinaces governing lhis type of work will be complied with whelher specifed horein or noL The�ranting of a permil does nol presume <br /> to give aulhonty lo violalo or cancel lhe provision of any olher slale or Iocai law regulatinc�construclion or lhe performance of <br /> construction.That I am aulhorized by the owner of this property to perform lhe work for which applicalion is made and I comply wilh the <br /> State Contraclors Law 18.27 RCW and 296.200 N�AC. <br /> , , ,_ , , , ���� � 10�, <br /> Signalure of OwnedConlractodAuthonzed Agenl D le <br /> I <br />