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PCRMIT APPLICATIC�N <br /> CITY OF EVERETT P�RMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATION3 ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE�S�DRESS PAF2CEL TAX I.D.# PERMIT il <br /> ��90i' �/� aiv,o � �ls%. �y'C���9Uo3oo �� l�� C�'c;'c '-�a- <br /> LEGAL LOTNO. BLOCK TR�CT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> ,�yGl/S �ti���/>>'/>�j .�cRC'`� f.1NlJ.'*i�y ��/'C� <br /> TENANT NAME CONTACT FOR PERMIT PHONE � <br /> CONTRACTOR ����T�, U��r/yG' ADDRESS GTY/ZIP PHUNF. <br /> /r <br /> /S�76�6.5���.� E// YoT/�"� 5`�%.�7Y�CG�f <br /> CONTR.LICENSE# /7U�,�//jy(G 8/Q` <br /> y <br /> USE OF BUILDING HEAT SOURCE CON7RACT PRICE OF WORK <br /> � <br /> Electric ✓ Gas Other >�� � <br /> WORK DESCRIPTION <br /> ,i1/�O ��,3. /_'✓-+%S <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Balhtub � Fo.ced air systnms <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen; ink&disposal Gas(ireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Waler heater Range hood <br /> Sink(service/badmop/elc.) Exhausl fan <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT IOCAL SAf_ES TAX CODE IS 3105 <br /> I hereby ceritify ihal I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied wilh whelher specified herein or nul The c�ranling of a permil does not presume <br /> to give authorily to violale or cancel the provision of any other state or toc;l law regulating construction or the performance o( <br /> construclion.That I am aulhorized by the cwner cf lhis property:o pedorm the work for which application is made and � comp�y with lhe <br /> Slate Contractors Law 1 .27 RCW and 236200 WAC. <br /> ��i=��- � v� � <br /> Signature of Own dContractor/Authonzed Agent D e <br />