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PERMIT 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 <br /> _> �/G� �t'� 5�:-�_/;,�v� <br /> SITE ADDRESS PARCEL TAX I.D.i{ PERMIT,f} <br /> �� �� ����r -i o <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITYlZIP PHC�E <br /> TENANT NAME 5 �a.�}�i.r� �� ( CONTACT FOR PERMIT PHONE <br /> 1 �� �`� � 1 2c��� ''L2�y �z `�� <br /> I'1N�^�^"r'�"5't`����+.ii� � 4 �2�y� E•MAIL <br /> Z.`�RAZ`f A RE 1 / I�li N <br /> �ve�� k 1irt- �;;`_ !s,(o�1� 5�� 5 � ?'i.,�� �- ��1' /� �I �° `/ � <br /> CONTR.LICENSE# �- <br /> /v!>���f �'YJ �2X' ( C, <br /> USE OF BUILDING HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> _Electric _Gas_Other I � �-6 e' V v <br /> WORK DESCRIPTION <br /> /�J-c.,,� ��l- jc:�', 1f� SilYJ7r�•Sl1n sj'J��^'" <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TUR[OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling unils <br /> vathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas ranye <br /> Clothes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink (service/bar/mop/elc.) Ezhaust fan <br /> Backflow prevenler Heal pump <br /> Urinal Urit heater <br /> Drinking Fountain Boiler <br /> F�oor drain Retrigeretion <br /> Greasc trap Woodstove <br /> Roof drains Other _ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify lhat I have read and examined this application and know the same to be We and correcl All provisions of laws and <br /> ordinaces goveming Ihis type ot work will be complied with wheiher specified herein or not.The graniing o(a permil does not presume <br /> to givo authority lo violate or cancel the provision of any other slate or local law regulating wnstruction or the performance o( <br /> construction.That I am authorized by the owner oi this property to perform lhe work br which application is made and I comply with fhe <br /> State Contraclors Law 1827 RCW and 296.200 WAC. <br /> ��� . �30 ��J <br /> Signature of OwnedContractodAuthorized Agenl Date <br /> I <br /> IC <br />