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. � ` <br /> PERIVIIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES • . <br /> 3200 CEDAR STREET, EVERETT, WA 9820a <br /> 4?.5-257-8310—FAX 425-257-8857—www.everettwa.org <br /> 4PPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 FM (� (�(p � (� - (�Z� <br /> SITG ADDRESS �l-����t ��" PARCEL TAX I.D.# ,� � PEP.MIT# <br /> 'S�71L1 "CK� l� �Yerc'FIWA �`�2'�( ���,� ?3 �� J�(' ^'-) <br /> LEGAL LOTNO. BLOCK TRACT <br /> CESC. (� '�r� <br /> OWNER A�DRESS C CITY/ZIP PHONE 1(."�-J Z+L_2 �1 O <br /> ���Q/1)U+�fIOCUIr"�G, � <br /> �,Verc�+{ C�CL��c�Ry �rrl�-!' «G �� Rc�C���e�IIPrCCc� F.v����f-l� �r&i� <br /> TENANTNAME CONTACTfORPERMIT PHONE <br /> �I I�c�ri �lsl� { v«►�r� F r�i�i �-��i ��ez_ �.3c�� ) -r z z-cr;� <br /> CONTRACTOR ADDRESS �'ITYIZIP PHONE <br /> CONTR.LICENSE II 1v/�. <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ✓ Eleclnc �Gas_Other � 2 ��%�-J , <br /> �c� </C� Lr•rx�iix �i i%icc� — __ � � - <br /> WORK D CRIPTION • <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet �_ A/C-airhandlingunits <br /> Bath,ub Forced air systems <br /> � Lavalory(wash basin) _ ��as piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/barlmop/elc.) _ Exhau�t fan <br /> BackAow preventer Heat pump <br /> Urinal Unii heater <br /> rinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> � Roofdrains _ Other <br /> Oiher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> !hereby ceritify that I have read and examined this applicalion and know the same to be irue and correcL All provisions of laws and <br /> ordinaces goveming ihis type of work will be complied with whelher specifed herein or not.The granting rf a permit does not presume <br /> to give authonty to violate or cancel the provision of any other state or local law regulating wnstrudion or the pedortnance of <br /> construdioa That I am authorized by the owner of this property to pedorm he v✓ork for which appiication is made and I comply with the <br /> Stale,Coniractors Law 18.Q7 RGW and 296200 WAC. � <br /> � ;' ��'C"r ,��c� t�� ��� `-� �� C?C�. <br /> ig ure of OwnedContrador/ uthonzed gent/ Date <br /> �_--- '/z <br /> � <br />