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PC�CMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.overeltwa.org <br /> , - APPUC�TIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P�RMIT# <br /> !1��_ ��/ � L �; C". i�� ` (,c�% <br /> LEGA LOT N0. BLOCK TR� 'T <br /> DESC. <br /> OWNER ADDRESS � CITY2IP PHJNE /fZ�_�2_ 5� S <br /> r3 & g SNVES� MENrs Z�'s, � �� S-t . 1JE TU�A�P �Sz�i �2s-a�a-is ► <br /> TENANT NAME CONTACT fOR PERM1IIT PHONE <br /> BAI_gtR S iNGu Llts —Z31— 155 f <br /> CONTRACTOR AOORESS CITYIZIP PHONE <br /> CONTR.L:LENSE N ��� <br /> USE OF BUILDING � — HEAT SOURCE CONTRPCT PRICE OF WORK <br /> Eloclric __Gas Olhcr <br /> WORK DESCRIPTION <br /> �� ��� //�' i <br /> /� �1""'�� / �� � '' � � ; �. <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF PIXTURE OR ITEM <br /> Tallet A/C—alr handling units <br /> Bathtub Forced alr systems <br /> Lavatory(wash basin� _ Gas pfping <br /> Shower Waler hoalcr <br /> Kitchon sink 8 disposr, _ Gas firaplace <br /> Dishwasher Gas rango <br /> Clolhos washor _ Clothes dryer <br /> Wator hoalor Range hood <br /> Sink(sorvico/badmop/etc.) _ Exhaust fan <br /> BackOow preventor _ Hoal pump <br /> Urinal Unll hoater <br /> Drinking Founlain _ Boller <br /> Floor drain Relrfgoration <br /> Greaso Irap _ Woodslove <br /> Roof drains Othor <br /> Olhor <br /> CITY OF EVERETf LOCAL SALES TAX CODE IS 9105 <br /> I heroby ceriti(y thal I have road and ezamined thls anplicalion and know the same lo be lrue and corrocl. All provision5 0l laws and <br /> ordinaces governing this type of work will bo comp':ad wilh whelher spocified herein or not.The pranting of a permil dces nol presume <br /> to give aulhoriry lo clolalo or cancol tho provisic,i of any other slate or local law regulating consWction or lho pedortnance ol <br /> constniction.That I am authorized by Ihe oNnor ol this proporty lo perfortn the work lor which application Is made and I comply wilh Iha I <br /> Slato Contractors Law 18.27 RCW and 29f,200 WAC. <br /> `�g�� �b/►3 �oc <br /> Signa�uro of OwnodContractod uthorizod Agont eto <br />