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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 /> SITE ADDRESS PARCEL TAX I.D.# PE IT jt <br /> �>� ��� � ;�Y.���< < �� �� 9 <br /> LEGA LOTNO. BLOCK TRACT <br /> oesc. 14t "J � G <br /> ���'lNER ADDRESS CI IP HONE <br /> r1'��..� �. �- N�,-.�� < , �..,., ,-�� ����c�t �r��` /�N �.W�a� `l�dzyz <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �•�� S�e� 5 � �d,u�l,..1, >„ �,-I�w�� ti �igZ73 yz5737 isz <br /> CO iRACTOR ADDRE55� G 21P PHONE <br /> CONTR.LICENSE p <br /> Clas�� s 93U t3C� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��hi��fL FA�IhI�y ���710�C.6 —Electric _Gas_Olher ����� <br /> WORK DESCRIPTION / <br /> ,'i,� I SL �L/�r1-<.tr � +-tv tS�P{'F �L'� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR IiEM NO. TYPE OF FI%TUR[OR ITEM <br /> � Toilel A/C-air handling units <br /> Dalhtub Forced air systems <br /> � Lavatory(wash basin) _ Gas piping <br /> � Shower _ Waterheater <br /> Kilchen sink&disposal Gas freplace <br /> Dishwasher Gasrange <br /> � Clothes washer � Clclhes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/elc.) _ [xhausl fan <br /> Backflow prevenler Heal pump <br /> Urinal Unit healer <br /> Drinking Founlain Boiler <br /> Floor d:ain Refrigeration <br /> Grease lrap Woodslovo <br /> Roof drains Other <br /> Olher <br /> CITY OF LVERETT LOCAL SAIES TAX CODE IS 3105 <br /> 1 hereby ceritify that I have read and examined this application and know ihe sanie to be true and correct. All provisions of laws and <br /> ordinaces governing this typo of work will be complied with whether specified herein or nol.Tho granting o(a pennit does not presume <br /> to give aulhoriry to violale or cancel the provision o(any other state or�ocal law regulating conslruclion or ihe performance of <br /> consWction.That I am authorized by Iho owner of this property to pedorm the work(or which application is made and I wmply with ihe <br /> State ConVactors Law 18.27 RCW an 96.200 WAC. <br /> ��/: ..� �-�� ��r /,�`7 <br /> Sig'�r atur edContractor/A horized Agent D� � <br /> Z <br />