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PtRMIT APPLICATII�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS '�— �i�'• ' PARCEL TN(I.D.# P RMIT# / <br /> 3�'�.3 Cl� • C/-�'S i NA 21� � / �� - � C/ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �a� �JL <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 6�E�rvc ,�r�.�� ,,, 2s�, uzr 8�rt �z,��� <br /> CONTRACTOR ADDRESS CITV2IP PHONE <br /> r��e <br /> CONTR.LICENSE n <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> M j�(�� _Eleclric _Gas_Olher 33 a-� <br /> I <br /> WORK DESCRIPTION <br /> /NST?�-C., �ZS- (.fr �r�p�'N f�� �,aL� <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handlinp unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Cloth�s washor Clothos dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/elcJ Exhausl fan <br /> Backflow prevanter Heal pump <br /> Urinal Unit iiealer <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Greaso lrap Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritify that I have road and examined this applicalion and knuw the samo to be lrue and wrrect. All provisions o(laws and <br /> ordinacos governing lhis type ol work will bu complied with whother specifiad herein or not.The granting of a permil does nol presume <br /> lo give authority to violale or cancel the provision of any other state or local'nN regulating consWclion or lhe peAormance of <br /> construction.That I am aulhorized by the owner of this property to perform lhe ,vo.A for which application is made and I comply with the <br /> SI�Co�lracto��.27 RC and 2�.7,�N/�. <br /> G � / <br /> �gnalu e of OwnedConlractor/Authonzed Agenl Date � <br /> L <br />