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PE� .MIT APPLICATIOI� <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 <br /> SITE ADDRE33 �-2� PARCEL TN(I.D.N ,/ERMIT N <br /> 3�3 U.�• CI-}s �ivo /GD LJ 0_� �("7 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> 3�r�J6 <br /> TENANi NAME ( CONTACT POR P[RMIT PHONE <br /> Q�I NG. <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> G��E'ti�,-t- <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> /}��1-E M1-tr hT' /1/f�(, � I ,ElecUic _Gas_Other �S� d pd <br /> WORK DESCRIPTION <br /> /�ST/}L�- �'SPlLESto 5TA-�•i <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR IiEM NO. TYPE OF F�XTURE OR ITEM <br /> Toilet A/C—air hendling unlls <br /> Balhtub Forced air syslems <br /> Lavatory(wash basin) _ Gas plping <br /> Showor Water healer <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washar Cbthes dr�or <br /> Laundry iray _ Ranga hoad <br /> Sink(servica/badmop/otc.) _ Exhausllan <br /> Backllow prevenlor _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boilor <br /> Floor drain Re(rigeralion <br /> Groase trap _ Woodstove <br /> Roof drains Other_ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> �horeby cerilify thal I have road and examined lhis application and know lhe same lo be lrue and conect. All provis�ons of laws and <br /> ordinacos governing this lypn of work will be complied with whether specified herein or not.The granting of a permii does nol presume <br /> to givo aulhority lo violate or cancol the provislon of any olher stale or local law regul2ling conslructlon or ihe perfortnance of <br /> construction.Thal I am authorizad by the owner of this property lo peAorm Ihe work for which applicalion Is made and I comply wilh lhe <br /> Stat CoNrectors Law 18�-7�C�W� d 29�.200 WAC. <br /> ��� ��'`""'�'� 3�?��'C <br /> Signature ol Ownerl ontractorlAulhonzod Agenl Date <br /> � a <br />