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PCRMIT AP�LICATIvN <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 ADDR SS PARCEL TAX I.D.# PERMIT q <br /> ��1� �f��,d� Iv1G 7 �G •v cy <br /> LFGAL LOi NO. BLOCK TRl+CT OR SUBDIVISION# <br /> DESC. <br /> OWNIER A�DRE55 CITYIZIP PHONE <br /> IICI��j�'�1 � • U� � a y 5�1N1G� �Ncil� � � ��VN� -1(jCX.�� 11 �� 1��� (fOq <br /> TENANT NAh1E CONTACT FOR PERMIY`T PHONE <br /> _ �u5ca�,�" <br /> , ,- '' �AII qOV1�S I�M �P. �SC�IqMa1/� E-MAIL <br /> CONTRACTOR , AD SS CIiY21P PHONE <br /> � �,�,���� ��u�,«,i a��� �«� c�� i y��w«� �1�5 7�'�1 -���9> <br /> CONTR.LICENSE# �^M�y �( � p5s�7� p�i�r�7 <br /> l.� r— 1 <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric ,�Gas Olher �� 1�e�'. �'�' <br /> WORK DESCRIPTION �``M(1 �c� S II /k., �c �u rylqC� �`" I-t,�{' Wc1� 7'1.� �j(, . 1 V� S-'yl l/ <br /> nEw .�v�r�lu�,c. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEA7 <br /> Toilet A/C–air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower � Waterheater <br /> Kilchen sink&disposal Gas firepface <br /> Dishwasher ` Gas range <br /> Clothes wasner Clothes dryer <br /> Waler heater Range hond <br /> Sink(service/badmop/eta) Exhaust fan <br /> _ Backticw prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhat 1 have read and examined lhis applir.ation and know lho same to be We and correct. All provisions of laws and <br /> ordinaces goveming this rype of work will be complied wilh whether specified herein or not.The granting o(a permit does not presume <br /> to give aulhonly to violale or capcel 1he provision of any olher state or local law regulating construction or the performance of <br /> construclion.Tt7at I arTyaulhorized by tho owner of this property lo per(orm the�vork for which applicalion s made and I comply with the <br /> State Contr�e(ors L�Z4✓18 27 RCW and 286.200 WAC. <br /> .., ����- ��1��/�� <br /> „' �-i .f <br /> Sigha ure ol OwnedContraclor Authonzed Agent Date <br />