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P RMIT APPLICATI N <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 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE AUDRESS PARCEL TAX I.D.N PERMIT N <br /> IS E •CRs� �fl . C�? 93t0004ol�-Ioa. <br /> LEGAL lOTNO. BLOCK TRACT ���� <br /> DESC. I Q� Q��,Q1.1:Y �AAC ♦�c.n�-TS <br /> OWNER A DRESS C�TY21P PHONE <br /> H��,dc 6�5 �►�5-� �aaa ���q�. ►�t �� q�z°S �IZS-39�-� 360 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> I �el �-►Uac�C W2,S-2`K�•2y Z9 <br /> CONTRA TOR ADDRES ITY PHONE <br /> N� 6P.os. Cc�usT• �9 22 �'l�R�i: 1�G El�t �lds I�2S 3V�-�3 6 0 <br /> CONTR.LICENSE M <br /> HFIA�k C3'zv�d.PZ — <br /> USE OF BUILDING HEAT SOURCE I COMTRACT PRICE OF WORK <br /> ��� _Electdc _Gas_Other <br /> WORK DESCRIPTION <br /> �D EMO <br /> PLUMBING MECHAN�CAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C—air handling units <br /> Bathtub _ Forced air systems <br /> Lavalory(wash basin) _ Gas plpinp <br /> Shower _ Waler healer <br /> Kitchen sink 8 disposal _ Gas(Ireplace <br /> Dishwasher _ Gas renge <br /> Clothes washer _ Clolhea dryer <br /> — ry Y Rf n e hood <br /> S nk(serv ce/bar/moplelc.) _ E�.hausl fan <br /> Backflow preventer _ Heat pump � <br /> Urinal _ Unit heater <br /> Drinking Fountain Boller <br /> Floor drain _ Refrlgoralion <br /> Grease trap _ Woodslove <br /> Roof drains _ Other <br /> Olher — <br /> I <br /> j CITY OF EVERETT LOCAL SALES TAX COOE IS J10S <br /> i <br /> � I hereby ceritify lhat I have read and ezamined this application and know the seme lo be true end correct. All provisiors of lawa and <br /> � ordinaces governing this type of vrork will ba complied wilh whether specified herein or noL The gr2ntlng of a permil does nol presume <br /> to give authonty to violate or cancel the provision ol any other stale or local law regulaUng constructlon or lhe peAortnance of <br /> construction.That I am aulhorized by tha owner of this property ro perfortn lhe work far which applicalion is made and I comply with lhe <br /> State Contrac Law 18.27 RCW and 6.200 WAC. <br /> � Zc D <br /> Sig ature wnerl ontracro nzed A nt ate <br />