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P`tRMIT APPLICATI(�N <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 - r _ li <br /> ,' <br /> SITE ADDRESS � PARCEL TAX I.D.tl PF,R�IT• � <br /> � � � � <br /> LEGA LOTNO. BLOCK TRACi . <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHON <br /> �o� �.�1�2�.Tr e-�VI'� �aaa �3r�cf��if 9oa0� <br /> TENANT NAME CONTACT FOR PEItM1T PHONE <br /> �F�1.�-�► C�IIRCtI� �� t.c.�+1z-1r1�A1L� �`�Zs�SOo° -313� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> -�-b¢�-z-�RT1oz I I��-7 (�I�`� a� �U�r�r� C'{zs) &�I-333� <br /> CONTR.LICENSE p_, <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> `/ /" ,� <br /> C7fl/J�'��E E V Electric _Gas_Olher Gj w�"7 <br /> i <br /> WORK DESCR�PTION <br /> -'cJ(2�U15+� -�D i,vS�U- � �� ��-P �D �C-(�JS"i� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> Toilel � A/i,—air f�andling unils <br /> Bathlub Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> � Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(serviceNar/mop/elc.) � Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiior <br /> Floor drain Refrigeration <br /> Grease lrap Woodslova <br /> Roo(drains _ Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined this application and know the same lo be lrue and correcL All provisions of laws and <br /> ordinaces veminc�this type of work will be complied wilh whelher specified herein or not.The granting of a pertnit does nol presume <br /> to give �ho ily to vioiat r n�el the provision o1 any other state or local law regulating construction or lhe performance ot <br /> con :iuclion 7h fl 3 ulh iz d by the owner o(this property to peAorm the work for which applicalion is made and I comply with the <br /> St e ntr lo s� 18. R W and 296.200 WAC. <br /> 11- 18-0� <br /> Si Wre of wnedContrector/Authonzed Agenl Date <br /> �lL) <br />