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, <br /> PtRMIT APPLICATION <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 9.a-O—O,'�"j <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT N <br /> � ��S H, S � - a� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> S��N�}y /�� d�tf✓NF� Ir' <br /> TENAN� CONTACT FOR PERMIT PHOlIE <br /> S'1'/'y2l�wck S �fc ��� I s�f✓E �r1yFi��r�/ �Z�6� 21L-09ia <br /> CONTRACTOR �/.�/�Un/AL f�6'n/ �j�(lJ ADDRESS CITV2IP PHO <br /> /"/l / ,ZS� WeT✓/�9K<�N'F i✓ C266 �2-�?00 <br /> CONTR.LICENS@ fJ ����OS�O g��� <r�� �_,y �/G <br /> � �c v-o [ <br /> USE OF BUILDING I — HEAT SOURCE C NTRACT PRICE OF WOR': <br /> Electric _Gas Otber Z/�� <br /> WORK DESCRIPTION <br /> /�✓srinc o�✓F si�✓6� ��tE �LcwYv�/�fEJI f,�t ,Si�✓- <br /> PLUMBING MECHANICAL <br /> NO. 7YPE OF FIXTURE OR ITEM NO. TlPE OF FIXTURE OR ITEM <br /> Toilet AIC–air handiing units <br /> Balhtub Forced air systems <br /> Lavatory(wash 6asin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(servicelbar/mopletc.) _ Exhausl fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Urnking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVEREIT LOCAL SALES TAX CODE IS 3105 <br /> I hereby c .ri fy thal have read �nd examined lhis applicalion and know the same lo be Irue and correcl. All prc�isions of laws and <br /> ordinaces g emin his type of work will be complied wilh whether spec�ed herein or not.The granting of a permit does not presume <br /> lo c�ive aul rity to olale or cancel lhe provision of any olher state or local law regulating constn;ction or lhe peAormance of <br /> constructio .That m aulhorized by the owner ot this property to pedorm lhe work for which applicaUon is made and I comply with lhe <br /> State Con� a lor L w 18.27 RCW and 29(i.200 WAC. <br /> �to-u�� <br /> Signature f wner ontracloNAulhorized Agenl Dale �/L <br />