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FERMIT APPLICA.TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-?_57-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM R AM TO 4 PM �/ 70�-- /� <br /> � <br /> SITE ADDRESS PARCEL TAX I.D.# 4ERMIT# <br /> 's' 7Z� �_�� ���J.w� ���� �-c,�3��. <br /> LEGA LOTNO. BLOCK TRACT � <br /> DESC. <br /> OWNER AD�RESS3��IC� �bf4�-��.�cy������P�o\ PHONE u u 21 Z ��L <br /> �, <br /> �_�,r� � P � �j;,�� �',.teC Lk r �l,L �'..'e� c{{y l+/�. !4�C.A <br /> TENANT NAME CONTACT FOR PERMIT � PHONE <br /> \iC ��'".� SL.� �•C'S�U.� �1.��` !_UtJ�–,9�5'� ! � 1 <br /> CONTRACTOR -�'�,,��'�, i� �rv�i�s ADDRESS CIN21P PHONE <br /> ��\�,a�`.o\^� i <br /> CONTR.LICENSEIJ � ����3�/�Y� <br /> �/U <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���� �U�� �elecMc _Gas_Othcr <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. 7YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel NC–air handling units <br /> bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal Gas lireplaco <br /> Dishwasher Gas rangc <br /> � � Clothes washer � Clolhes dryor <br /> Water healer _ Range hood <br /> � Sink(service/badmop/etc.) _ Exhausl tan <br /> �ackflow preventer Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstovo <br /> Roof drains Other_ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hP�eby cerili(y that I havo road and examined this application and know the samo to bo lrue and correcl. All provisions of la�.vs and <br /> ordi��aces governing lhis typo ot work will bo ccmplied wilh whether specified herein or noL Tho granting of a permit does not presume <br /> to give authority lo violalo or cancel lho provision of any other slate or local law regulaUng construction or tho pedortnance of <br /> conslruction.That I am aulhorized by lho owner o(this property to perform the work for which applicalion is made and I comply with the <br /> Slale Contraclors Law 18.27 RCW and 296.200 WAC. <br /> ��tr�� �C'��3' 3/ �/67 <br /> Signature of Owner/ContractodAuthorized Agent a—T le <br />