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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, 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.k PERMIT# <br /> y3a GLe��A�9 �r.e I (7l-Oo� <br /> IEGA LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��y:J� (�•,v,✓A ljv,z0�c.�' o�`/j� GGc�ac.+--9 /k� �v�.'ors <br /> TENANT NAME I CONTACT FOR PERMIT PHONE l�Zf 7S�/- � Je <br /> /� �� E•MAIL <br /> S�-S Ft.yo�rGl..lL <br /> CONTR.LICENSE M jf"S���G/3 7/" , I���I J ��/�" � i'�/C ���s✓it LC' yJ3 7f Y ��J� <br /> G�,(3�1i 1�� 7/ <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> S/ /� �[lectric Gas Olher �J/��� � <br /> WORK DESCRIPTION /��, „�o��� <br /> PLUMBING MECHANICAL <br /> NO. 7YPE OF FIXTURE OR ITEM N0. iYPE OF FI%TURE OR ITEM <br /> Toilet A/C–eir handling units <br /> � Oathtub Forced air systems <br /> Lavalory(wash basin) Ges piping <br /> Shower Waler hoater <br /> ! � Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher Gur range <br /> _ Clothes washer Clothes dryer <br /> _ Water heater = Range hood <br /> _ Sink (service/bar/mop/etc.) Exhaust fan <br /> BackOow provenler Heat pump <br /> Urinal Unit healer <br /> Urinking Founlain Bailer <br /> f loor Arain Refrigeretion <br /> _ Grease Irap _ Woodstove <br />� Hoof drains Other <br /> � Other rq� 5/A�r-ofF — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certlly Ihat I have read and examined Ihis applicalion and know Ihe same lo be true and wrrect. All prwisions of laws and <br /> ordininces goveming Ihis type ol work will be complied with whelher specified herein or not. The granling of a pertnit does not presume <br /> lo give authorily lo vidate or cancel Ihe provision of any olher slale or local law reguleting conslructlon or Ihe performance ot <br /> construclion. Thal I am aulhorized by the owner of this property to periorm the work for which application Is made end I comply with the <br /> Slate Contractors Law 18 27 R 2�36.200 WAC. <br /> � /�.�r � <br /> /� ��/ C �'.77'/U <br /> �5�gpa et�oi�wnedContractodAulhorized Agenl � Date <br />