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PE�tMIT APPLICATi��� <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&CREDIT CARDS ARE NOT ACCEPTED <br /> SI7E ADDRESS PARCEL TAX I.D.0 PERMIT� <br /> � 0 ��.r� ✓r�� lnoyoq -033 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> 0 NER ADURESS CITY2IP PHONE <br /> xA,�r FnJKc� 0 S,C ? �M�itrf�a 2aG23z-/s"9 <br /> TENANTNAME ONTACTFOR PERMIT PHONE <br /> �Q( K �U�c �1/�N�i 26G 23L/596 II <br /> t�ONTFiACTOR ADDPESS CITYlLIP PHONE �,, <br /> CONTR.LICENSE!i <br /> USE OF BUILDINO HEAT SOURCE CONTRACT PRICE OF WORK <br /> �u ��N�'� _ElecMc _Gas_Other <br /> WORR DESCRIPTION <br /> � / �NS�Nt_t_ �n-��Jc.rr-I U���>g� R�a�-rus� Pxrz r`or- AS <br /> 1 rz����.t.�.9� <br /> PLUMBING MECHANICAL <br />�� NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR�TEM <br /> Toilet A/C—elr handlinp unila <br /> Bathtub Forced elr ayetems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas flreplace <br /> Dishwasher Gas renge <br /> Clothos washer � Clolhes dryer <br /> Laundry tray Range hood <br /> Slnk (servicelbar/mop/elc.) _ Exhaust fan <br /> Backilow preventer _ Heat pump <br /> Udnal UNl heater <br /> Drinking Fountain _ Boller <br /> Floor drain Refdgeretlon <br /> Greasetrap _ Woodstove <br /> Roo�drains Olher <br /> Olhor <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J10S <br /> I hereby ceritify that I have read and examined lhis application and know lhe same ta be true end cortect. All provlslons of lewe and <br /> ordinaces governing this type of work will be complied with whether specified herein ar not.The granting ot a pertnit does not preaume <br /> to give authority to violate or cancel the provision of any olher state ar local law regulating canatructlon or lhe performance of <br /> construction.That I am aulhorized by lhe ownar of this property to perform the work lor which applicatlon ia made and I wmply with the <br /> Slate Contractors Law 18.27 RCW and 296.200 WAC. <br /> ,�ry� ' ' - � I- zZ`t <br /> Signature o wnen tractonAulhonzed gent ate <br />