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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.everethva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 37Z� ('>rp�G�r d0 3 D D �'��'�`��"�}�' <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER AD�RESS CINIZIP PHONE <br /> �a�i�f" �� l-�o`dr��S 3Z26 j3rouvl.��c�, 30� �ve�rP� �¢Zs)Zla-Zz�b <br /> TENANT NAME CONTACT FOR PERMIT VHONE <br /> ��,r��c p (2�ob) 69z-s000 <br /> � `�J��✓�j�(/�.Y{'t(�S E•MAIL <br /> NTRACTOR D S / I HON <br /> Dl����� �'e�erQ� LoKf�a.��i^ 37Z6 �3roadui/tiy 3oZ <br /> CONT LIC NSE � ����D� �U'7� <br /> ! <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK I <br /> ��� s�" �SDD� <br /> D��� _Eleclric �Gas_Other � <br /> WORK DESCRIPTION <br /> �wa��t ,�c��Yv��t�e�`� �f sG�e�l o�-�� spa�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet _ AJC-air handling units <br /> Bathlub Forced air syslems <br /> , � Lavatory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> --���{ � Gas range <br /> Clolhes was r Clolhes dryer <br /> Water heater Range hood <br /> � Sink(serviceN r/mop/elc.) _ Exhaust tan <br /> Backflow preve ler _ Heat pump <br /> Urinal Unil heater <br /> Drinking Fount in _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodslove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this appiicalion and know lhe same lo be true and correcL All provisions of laws and <br /> ordinaces governing this type of work will be complicd with whether speci(ied herein or not.The granling of a permit does not presume <br /> to give aulhonty lo vio�ale or cancel the provision of any olher slate or locai Iaw regulaling conslruclion or lhe pertormance of <br /> construction.That I am authorized by the owner of this property to periorm the work for which application is made and I comply with the <br /> State Contractors Law 1 27 RCW and 296.200 WAC. <br /> ��%�-�2 ���� d�2b�47 <br /> Si ature of OwnedConlractor/Authonzed Agent Date ��L <br />