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PtRMIT APPLICATION <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 � �- J g -07 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> U� l'r-t +5� �L1 �CI - � Z <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITY2IP PHONE <br /> /A �a�" �N�,= Il c i T,� S l 7�� � >� !��/ �'�I"i y1s-zs� - yv.;a- <br /> TENANT NAME CONTACT FOR PER IT PHONE <br /> CONTRACTOR S �J� �'IL�,(S ADDRESS S CITYIZIP PHONE <br /> 1 UJ ll 3 (�.'� :a-�= #� ���Y`e�" `�ZS' � )''7 _��7b'� <br /> CONTR.LICENSE A <br /> `���v � �Pui ��� — <br /> USE OF BUILDING I — NEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other �J�� � <br /> WORK DESCRIPTION <br /> 'J_ �A..Gx � � S i�•� W�tV {^['4�'— (�h �41.L1'�L.t r� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin� Gas piping <br /> Shower �_ Waterhealer <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Cblhes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust fan <br /> Backllow prevenler _ Heal pump <br /> Urina� Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Rririgeration <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Oiher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify lhal I havn read and examined this application and know lhe same to be true and correct. Ail provisions of laws and <br /> ordinaces 9overning this type of work will be complied wiih whether specified herein or nol The granting oi a permit does not presume <br /> to give aulhority lo violale or cancel the provision of any other stale or local law regulating�Anstruction or the peAormance of <br /> construction.That I am authorized by the owner of this property to perform the work}or which applicalion is made and I comply with lhe <br /> Stale Conlractors Law 18.27 RCW and 296.200 WAC. <br /> .�—' �y�� _ /�/b/o 7 I <br /> 0 <br /> Signature of Own ConUact /Authorized Agent � Date <br /> _—J <br />