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� <br /> 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 ACCEFTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS F?,RCEL TAX I.D.# PERMIT# <br /> 372G 8�� �'��`� - / � <br /> IEGAI LOTNO. OLOCK TRAC7 <br /> DESC. <br /> OWNER AUDRESS CITY/ZIP PHONE <br /> .fTc�(�P�-���"� <br /> TENANT NAME CONTACT FOR PEI2MIT PHONE <br /> �il�t� �H�►d�u14�"✓ l�,c�4T�5 ST��� z�,�lTfrtci�✓ �ie�) 2P2—orcv <br /> CONTRACTOR �,/'�����/� f/�� GMP•A�DRESS �jff{.�jJJ*/(f�V��✓ STYrz�P_'` PHONE <br /> f�1T�� <br /> CONTR.LICENSEO ,✓�Tosco�rn3 � � . 4,91uq <br /> �zab� 2d2 -�>� <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electnc Gas- Other �j 6'�s�� <br /> WORK DESCRIPTION <br /> I,�st� e,�c ���.:�,��,�9TF� wr�c S��✓ A�sA�y <br /> PLUMBING M[CHANICAL <br /> Np, � TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> Bathtu6 Forced air systems <br /> _ Lavatory(wash basin) . _ Gas piping <br /> Shower . Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Ctothes washer � Clothes drycr <br /> l aundry Iray _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhausl fan <br /> Backflow preventer _ Heat pump <br /> Urina� Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refngeration <br /> Grease lrap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby centify that I have read and examined Ihis applicalion and know Ihe same to be true and correcl All provisions of laws and <br /> ordinaces g vemin this type of work wili 6e complied with whether specified herein or nol.The granting of a permit does not presume <br /> to give aut rity to olate or cancel the provision of any other stale or local law regulating construction or the performance of <br /> constructio . That I m aulhorized Gy the owner ot this property to perform the work for which application is made and I comply wilh the <br /> State Contr c rs 18.27 RCW and 296.200 WAC. <br /> / 6•2f-�8 � <br /> Signature t ned ntreclor/AuthorizedAgent Date �/2 <br />