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PtRMIT APPLICATIVN <br /> CITY OF EV�RETT 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 PIN <br /> SITE ADDRESS �UE R(1 Y w^ `� a'a��' PARCEL TAX I.D.B PERM�,F� � <br /> U `� � C SIN � � �� <7''� ' O�S <br /> LEGAL LOT NO. BLOCK TRACT OR SUODIVISION fl <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE � 3G�,� ��,� Gy�,� <br /> -� L' L� ��C 4'Nd�d f�L �=f li�'�L' I�E��Na ��A1�2- E-MAIL <br /> ADDRE � <br /> CONTR.LICENSE p C�g `� U,,,, 1��,,d ) C S �.J (� L 1�' � 9' ` (o µ � <br /> USE OF BUII,DING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Eleclric _Gas_Olher � �C � <br /> WORK DESCRIPTION <br /> I �� � . �_[ 3 �o��� c� ,.,K � ���„ � ci�K � /lqo� C �r�L � <br /> , / / , <br /> „ r,,.e <br /> �' �n ,..�,� �,.�R // ��c?�,�. �,c�(�/� dTJ f'c i�� �;f�� R..;�-r-�� i �yr+�� <br /> --��� PLUMBING MECHANICAL <br /> NO. TYPE OF FI%iURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilot _ A/C-air handlinc�imils <br /> Dalhlub _ Forcod air syslems <br /> Lavalory(w2sh basic) _ Gas piping <br /> Shower _ Walerhoaler <br /> Kilchen sink 8 dis{wsal _ Gas fireplace <br /> Dishwasher __ Gas rango <br /> Clolhes wash�r _ Clolhes dryer <br /> Wa�er hoatcr -� _ Ranpc hood <br /> � Sink(service/badmoplelc.) � �� �"`�'`� � �� _ Exhaustlan <br /> _ Back(low prevenler / '', � __ Heal pump <br /> Urinal � /` - _ Unit heator <br /> Drinking Fountain _ Boiler <br /> Floor drain __ Relrigeration <br /> Grease trap _ Woodslove <br /> Roof drains _ Other _ <br /> Olhor--------- — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby cori.ify Ihal I have read�nd ezamined this applicalion and know Ihe same to be true and correct. All provisions of laws and <br /> ordinaces goveming lhis lypo of work will be compli�d wilh wholher specilied herein or noL The granting ol a permil does nol presume <br /> to c7ive aulhorily�o violate or cancel the provision of any olhei slate or local law rogulalinc�conslrudion or ihe pedormance ol <br /> construclion. 7hat I am aulhorized by Iho owner ol lhls property lo peAorm�he work for which applica�ion is maAe and I comply wilh the <br /> I Statc Contraclors Law 1t3.27 RCW anA 256.20U WAC. <br /> iJT • ..<-i� �c....cR Q b G- oy-(�� <br /> Siynt�tur�ol O +nedContracbuAulhori�Agenl Date � <br /> �Z <br />