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PEI�MIT APPLICATION 6 � � 3 ,.a� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, E��ERETT,WA 98201 /' r <br /> 425-257-881 U- FAX 425-257-8857-www.everettwa.org �� ��y � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T04 PM C ��ji�L/ -� <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT N <br /> i 3�� < � a��� e � o r r o0 <br /> LEGA LOTNO B�L]OCK TRACT � �.�/J � <br /> DESC. �� ` Iol 0�3"�� � �I�� �/ �1'.<.P <br /> OWNER AD I H <br /> 9e2�3 <br /> �„� v��w ��+�«��.� s �G. �GK a�Y� ����- y�-�e�o- ��y� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR C�A�E ,�S A.bc�e ADDRESS CITY2IP PHONE <br /> _) <br /> CONTR.LICENSEM SvunQ CL �'75 f K Q <br /> USE OF BUILDING NEAT SOURCE ( C TRACT PRICE OF WORK <br /> 5 � R _Elactric �Gas_,Other � /,3Q, OG G <br /> WORK DESCRIPTION <br /> S�-� r�,� l � ?�i�-� <br /> PLUMBING MECHANICAI <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilol A/C—alr handling units <br /> � Bathtub = Forcod air systems <br /> ,� Lavatory(wash basin) � Gas piping <br /> Shower Water heater <br /> T Kitchen slnk 8 disposa� � Gas fireplaco <br /> � Dishwasher Gasrange <br /> _L Clolhos washo• Clothes dryor <br /> �_ � kange hood <br /> Sink(servico/bar/mop/olc.) � Ezhausl fan <br /> Backflow preventer _ Heat nump <br /> 1lrinal Unil healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Relrigeration <br /> Grease trap _ Wuodstove <br /> Roof drains Other <br /> Glher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 310. <br /> I hereby coritify lhat I have road and examinod this applicalion and know Ihe same to be true and correcl. All provislons of laws and <br /> ordinacr,s governing this typo uf work will bo compliod wilh whothor specified herein or nol.The granling of a permit does not presume <br /> to give authority to violale or cancel Ihe provision of any other slate or local lar+regulaling construction or the performance ol <br /> construclion.Th I aut od by the owner o_f�th�is Lro_perly to perform lhe work tor which application is made and I comply wllh the <br /> Slato Cont o � 7 RCW and 'lOQWAC. <br /> i��� y��%�� <br /> SignaWre of GwnadContreclor/Authonzed Agonl Date I/� <br /> L <br />