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P'�RMIT APPLICATI(..N <br /> CITY OF EVERETT PERMIT SERVI�CES <br /> 3200 CEDAR STREET, EVERETT, WA 982U1 <br /> 425-257-8810 —FAX 425-257-8857—www.everetriia.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CAROS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P MIT p <br /> rlvtiv C�A � 00343 /Z o S�k�a , <br /> LBGA LOT NO. � BJ,OC T ACT <br /> OESC. ZZ GYCI. �/y'/S/0/lI /�, S <br /> OWNER ADDRESS CIN/ZIP PHONE <br /> s`ralEN G . �,2c►vc��� 7v�c� �/�Qy �D [�/� 9F�3 `/zs7s�Y78 <br /> TENANTNAME CONTACTFOR PERMIT PHONE <br /> �,1 7 �T' 1 � f J"�/T , , �1 � �.-' � <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> . . .• � ,�„ � 11.', 1 • . : ^ . • <br /> CONTR.LICENSE p ' ' � • '� � � • `� • � <br /> USE OF BUILDING I � HEAT SOURCE � CONTRAC7 PRICE OF WORK <br /> G� /�(V(_i`� Elocldc _Gas_Othar <br /> WORK DESCRIPTION <br /> 3ok 3 � <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet PJC-air handling unils <br /> DathWb Forced alr systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Wator huatar <br /> Kilcliun sink R disposal Gas(ireplaco <br /> _ Dishwasher Gas rango I <br /> Clolhes washer Clothos dryer /� ' <br /> _ Laundry tray _ Range hood � " <br /> _ Sink(service/badmop/eta) ( Exhaust lan <br /> Backilow prevonler Heat pump <br /> Urinai Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Relrigeralion <br /> Greasc trap Woods�ove <br /> Rool drains Olhor <br /> Olher <br /> CIN OF EVERETf LOCAL SALE5 TAX CODE IS�705 <br /> I horeby corilify Ihal I have read and examined ihis application and know the samo to be Irue and correcl. All provisions of laws and <br /> ordinacos goveming ihis typo o(work will bo complied wilh whother speci(iod herein or noL The gran;ing o(a permit duos not presume <br /> to give authority to violato or cancol lho provision o(any olhor stale or local law regulaling conslruction or ihe perlormance of <br /> conslruction. That I am authorized by ihe ownm ul lhis property to perfonn the work lor whirh application is made and I comply with lhe <br /> Stalo Contractors Law tA.27 RCW and 296.200 WAC. <br /> Siynatwo of wnodConhacrodAuthorizod Agent ata i/L <br />