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PtRMIT AP�LICATIC��I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREE", EVERETf, WA 98201 <br /> 425-257-8810 - FAX 425-2.57-8857 -wvw✓.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SI7E ADDRESS n PARCEL TAX I.D.# PERMIT ti <br /> !9 ' r l 'l r �� 7b7 � 0 � � <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> t�GUl, OUiJ� I Hi NC�UVGi�I i�i�� E,rcacl �Ua� -�v¢ �vF��-i� 9830� 4�y a.�� 4557 <br /> TENANT NAME C01lTACT FOR PERMIT PHONE <br /> u <br /> E-MAIL <br /> R A �ftESS CI Y/ IP N <br /> CONTR.�ICENSE# <br /> W�-�_/ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIP7iON <br /> ��-� puP��x <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEA1 NO. TYPE OF FIXTURE OR ITEM I <br /> Toilet A/C—air handling units <br /> Balbtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace I <br /> Dishwasher Gas range <br /> Cblhes washer Clothes dryer ' <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> � Di;�king Fountain _ Boiler <br /> Floor drain Relrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF[VERETT LOLAL SALES TAX CODE IS 1105 <br /> I herehy 7tity thal I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinac governing this type o1 work will be complied wilh whether specified herein or not.The granting of a permit dues not presume <br /> to give aulhorily lo violate or cancel the provision o(any olher state or loral law regulaling consWclion or the pedormance o( <br /> construction.Thal I am authorized by lhe owner of fhis property to perlorm the work for which applicalion is made and I wmply with the <br /> State Conlractors Law 1827 RCW and 296.200 WAC. <br /> �_,( n � ,uP._� IK 07 <br /> �9ig o w er CoAkactor/Authorized Agenl Date <br />