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P�.�tMIT APPLICATIG�� <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 B AM TO 4 PM - DEBIT R CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRE33� PARCEI.TAX I.D.N PE 17/ <br /> ���� ������,-- � v� s�000���o� ,�iio-� <br /> LEC,A LOiNO. —U�/3 BLOCK TRACT <br /> DESC. � v <br /> NER ADDRE S H N <br /> �`�]G�,(�j C C��C� I I <br /> ' SE'.c7tY/ � �iv I)7n/'rn�7 S7- -SE.q�t'1e, �j8/o�, <br /> TENANTNAME �j CONTACTFORPERMI7 �y������ �,��� <br /> Of�r- La�� o� /F.`x-:7ctn / I � �` <br /> �fe�i� Pcir� �uw�te.0 � N� ) ',��1�1 - D \� <br /> CONTRACTOR ADDRE9S CITY2IP PHONE <br /> CONTR.LICENSE N <br /> USE OF BUILDING I MEAT SOURCE I CONTRACT PR�OF WORK <br /> _Eiectdc �Gas Other /U <br /> WORK DE9CRIPTIq N <br /> �o w oc�( , c�han�, o� u� -�com �Jv.S� r�a��t�n� �,w� d <br /> '��c�. c�'�',\aCu�e . �a�t� ��ol� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Tollet A/C-alr handling unils <br /> _ Bathtub _ Forced elr syatems <br /> _, Lavatory(wash basin) Ges plping <br /> _ Shower Water heater <br /> _ Kitchen aink 8 dlaposal Gas flreplace „�r <br /> _ Dishwasher _ Gas renpe / <br /> _ Clothes washer Clothea dryer � <br /> _ Laundry tray — � <br /> _ Sink(servica/bar/mop/etc.) _' Range hood <br /> Exhauet fan <br /> _ Backflow preventer Heat pump <br /> _ Urinal Unit heater <br /> Drinking Fountain <br /> � _ Floordrain Refrlgeratlon 'n <br /> _ Grease trap Woodstave <br /> _ Roof diains Other <br /> Other — <br /> _ — — � <br /> n <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 O <br /> I hereby ceritify thel� have read and examined this applicatlon and know the same to be true and cortect. All provlsionn of laws end � <br /> ordinaces governing this type of vrork will be complied wilh whether specifled herein or not.The grenting of a permlt doea not preaume <br /> lo give authority to vialate or cancel the provision of any other state or local law regulallnp conatructlon or the pertormance of � <br /> conslruction.That I am authorized by the owner of this property to perfortn the work for whlch applicatlon is made and I comply with the <br /> State Contractors La�1817 RCW and 296.200 WAC. <br /> -_-�c� �. . .,. � . <br /> �? �'�.�1`�� ��t�_�_.�.,_��� ��\�-�\�`\ ' <br />� Signature o1 wner/ ontractor/ uthonzed geA nt '�e � <br />