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P��MIT APPLICATIO�� <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 ADDRESS PARCEL TAX I.D.p PERMIT q <br /> 2oZ i �_ Mo5o7-01'� <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER � ADDRESS CITY2IP PHONE <br /> �!!��n� �'c� /D/�7 3c�Ar,e��F �� �S�P o 37-53f�o <br /> TENANTNAME CONTACTFORPERMIT <br /> �iD T �i n .�vC <br /> CONTRACTOR � ADDRE53 CITV2IP �P��N€ �--I_y�f�I <br /> ����5�� N�T��c 2�u� +�'� �� � <br /> CONTR.L�CENSE N q�s2°�-`/y3K <br /> CvFJZB55D22oT ��.�.//�.��'� <br /> USE OF BUILDING HEAT SOURCE �CONTRACT PRICE OF WORK <br /> /19d����� _Electdc XGas_Other ������-=� <br /> U <br /> WORKDESCRIPTION ���Sh � �j,�s'rykl.� NdkKl:�I+�►� ��+�+ � rX Z <br /> 5f��-k� 1��- � R U D � 6ucr 0� lk�-s� Qe(lecfc UN�T <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–alr handling urits <br /> Balhtub Forced air syslnms <br /> Lavatory (wash basin) � Gas piping <br /> ! Shownr _ Waler heater <br /> I _ Kitchan sink 8 disposal = Gas Tireplace <br /> Dishwasher Gas range <br /> ' Clothes washer _ Clothes dryer <br /> i = Laundry lray Range hood <br /> Sink(service/badmop/etc.) = Exhausl fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unil heater <br /> i Drinking Fountain _ Boller <br /> Floor drain _ RefrigeraQon <br /> �� Grease trap _ Woodsto��e <br /> Roof drains _ Other <br /> Olher — <br /> CIN OF EVERFTT LOCAL SALES TAX CODE IS J105 <br /> � I hera6y cerility that I have read and examined this application and know tho seme to be true and conect. All provisions o(laws and <br /> ordinaces governing this type of work will 6e complied wilh whether specified��erein or noL The Qrenting of a permit daes not presume <br /> � lo give authonty to viol,te or cencel tho provision ol any olher state or local law regulaling consWction or the perfortnance of <br /> construc:ion. That I am authorized by the owner of Ihis property to perform ihe work for which application is made and I comply wilh iha <br /> State Cont2ctors Lavi 18.27 RCW and 296.200 WAC. � <br /> S�gna �re o wnerl ontractonAuthonzed Agent _ a1e yy <br /> _---���__—- <br />