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PtRMIT APPLICATIC�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 <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT N <br /> ��� % � ��Ec�CI,� .�� � �0� � " -'�� <br /> LEGAL LOTNO. BLOCN TRACT <br /> DESC, t �L7 �'EC�,! .S ✓-E���� `'I�`20I ZI�>�Cr�O- <br /> OWNER ADDRESS CITV/ZIP PHONE Uy�S <br /> f J('"�. �� .SCI'L4 ._ 1 /1 r�2 I`� )([hC ' (t`135 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> CONTRACTOR ADORESS CITY2IP PHONE <br /> CONTR.LICENSE p <br /> USE OF BUILDING — HEAT SOURCE I CONTFtACT PRICE OF WORK <br /> Electric _Gas 'r: Olh�3r <br /> WORK DESCRIPTION <br /> � C�_�.1 � � tI�" 4L� �{-,' �c u rt�F � <br /> �tiiiFZfi►' 1�uniti�l�t� r , I ,�� �' r��n� <br /> � � �� s�lca <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI%7URE OR ITEM NO. TYPE OF FiXTURE OR ITEM <br /> Toilet A/C—alr handiing units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) � Gas piping <br /> Shower Wator hoaler <br /> Kilchon sink 8 disposal Gas fireplece <br /> Dishwasher Gasranga <br /> Clothes washer Clolhes dryer <br /> Water healor Range twod <br /> Sink(servico/barlmop/etc.) Ezhaust fan <br /> Backflow prevenler Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Boller <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Olher _ <br /> Other <br /> CITY OF EVEREiT LOCAL SALES TAX CODE IS 9705 <br /> I hereby ceritify that I have read and oxamined this application and know Ihe same to be lruo and correcl. All provlsions ol lawa and <br /> ordinaces governing Ihis type ol work will be complied wilh whether speclfied horein or nol.The granting ot a permil doas not presume � <br /> to give aulhonly lo violate or cancel the provislon of any olher stale or locei law regulaling construclion or the peAortnance o( �� <br /> construction.That I am aulhorized by the owner ollhis property to pertorm Ihe vrork for which application is made end I comply with Ihe <br /> Stale Gontractors Law 18.27 RCW and 2�J6.200 W/1C. �� <br /> . 1�r � -� ,: , 14� I <br /> Signature of OZv dConlractor/Authonzed Agenl Date �. <br />