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PERMIT APPLICATION <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 /> ANPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ���6 �()� <br /> SITE ADDRESS ` s ' PARCEL TlUt I.D.p PERMIT# <br /> ��j _ p5I <br /> LEG4 LOT N0. BLOCK TRACT OR SUBDIVISION M <br /> DESC. <br /> OWNER AUDRESS CITYIZIP PHONE <br /> 17D� f ^.IG <br /> TENANTMAME CONTACTFORPERMIT PHONE <br /> ��z�-. i�—zs 9y <br /> ���r�� ��G �-����» ���2�SKi � <br /> E�MAIL <br /> � <br /> �/}^� f�f��1-„( JD �cJr1C'I - <br /> CONTR. LICENSE N <br /> USE OF BUILDING NEAT SOURCE CONTRACT PRICE OF WORK <br /> r�� J�_�t�� �J('_ T'^ 1..� _Electric _Gas_Olhor �'� 1� �°U <br /> WORK DESCRIPTION <br /> c;cb^>>�i�.uc�. T' iv�i.r T��iC �!f E� <br /> PLUMBING MECHANICAL <br /> NO. '.YPE OF FI%TURE OR ITEM N0. TYPE OF FIXNRE OR ITEM <br /> Toilol NC—air handling unils <br /> Balhlub Forced air systoms <br /> Lavalory(wash basin) Gas piping <br /> Showor Weter heater <br /> Kitchen sink 8 disposal Gas(ireplace <br /> Dishwasher Gasrango <br /> Clothes washer Clolhas dryer <br /> Walor heater Range hood <br /> Sink(service/bar/moplelc.) Exhausl lan <br /> BacY,llow preventer Hoat pump <br /> Urinal Unit hea�er <br /> Drinking Fountain Boiler <br /> Floor drain kefrigeration <br /> Grcaso Irap Woudstove <br /> Rool drains Other <br /> Olhor <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby coritify that I have read and exammed this applicalion and know tha same to be true and correct. All provisions of laws end <br /> ordinaces�overning this type ol work will bo complied wilh whother specilied herein or noL The granling oi a p3rmit does not presume <br /> lo give aulhoriry lo violate or cancel the provision of any othor state or local law regulating wnstruction or the periormance of <br /> cnnstruction. That I am aulhorized by lhe ownar of this proporty lo poAorm the work lor which application is made and I comply with lhe <br /> S�ate ontraclors Law 18.2 RCW a 296.200 WAC. <br /> ��,n?t�.J� !"��i�'%+i''�j� ��/ C! <br /> Signa�ure o�C�,medConiractorlAutho�izod Agenl Dale <br />