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PERIVIIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEQAR STREET, EVERETT, WA 98201 <br /> 425-257-881 U-FAX 425-257-8857-www.everettwa.org <br /> , APPLICATIONS �E I'CC�PTED FROM 8 AM TO 4 PM <br /> � �'' <br /> SITE ADDRESS ��� � PARGEL TAX I.D.N I PERMIT# <br /> �003 W� C/fis/NB �D _ i 1i0�)03- v I 5 <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> (3oE � NC-� <br /> TENANT NAME CONTACT FOR PERMIT PHONE ZS• <br /> �D�il f�� L . AST�MI,jO/ZS'�I E�btaL <br /> i <br /> D�F+�a'�EN iNflvsr�z�hz- <br /> CONTR.LICENSE p <br /> USE OF BUILDING � NEAT 50URCE CONTRACT PR�CE OF WORK <br /> •��� SrO�,g� �jlrr 2A(i S _Electric _Gas_Olher �/7 � o00 <br /> WORKDESCRIPTION 2����� ��� ,c+�EG�.- gUf (.��ING <br /> co�✓s r�vc-7" P <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilol NC-air handling unils <br /> Bathtub Forced air systems <br /> Lavalory (wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchan sink 8 disposal Gas fireplaca <br /> Dishwasher Gas rango <br /> Clothes washer Clothes dryer <br /> Waler hoator Range hood <br /> Sink(service/bar/mop/olc.) _ Exhausl lan <br /> Backflow preventer _ Heat pump <br /> Unnal Unit healer <br /> prinking Founlain _ Boiler <br /> Floor drain Refrlgaration <br /> Grease trap _ Woodstove <br /> I _ Roof drains _ Other <br /> Othor <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 7105 <br /> I hereby cerilily thal l have read and examined this application and know the same lo be true and correct. All provisions ol laws and <br /> ordinaces governing this lype of work will bn complied with whather specified herein or not.Tha grenling of a permit does�ot presume <br /> to give aulhority to viotate or cancel the provision ol any olher state or local law regulating construction or the peAormance ot <br /> conslruction. Thal I am authorized by lhe owner of this propeAy to periorm tho work for which applicalion Is made and I comply with the <br /> State mraclors Law 10. RC�V and 296. 00 WAC. <br /> o�'�� �ti�f�'�� 3��;��� <br /> SignaWre of OwnedContractor/Authonzed Agent Date �/ <br /> �_ -- Z <br />