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PcRMIT APPLICATIC�N <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 B AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.N /. � �ERMIT ft <br /> �03 o cc,�� �- O!%'-�? f'���'�%l � o_� lS (� i c � / � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. � `i - ��Z (B LI Z S <br /> OWNER ADDRESS CITYIZIP PHONE <br /> «l2�) <br /> 4KR. AL 6ou�y �osc; � a�r�v &���,2�rr, w�i� zsv-7zs� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � I � <br /> CONTRACTOR ��ALl ADORESS dTYlZIP PHONE <br /> TY G1�aA�r-_ 3�v z.. 2 c.�c i<F�2 <br /> ��r��L� , Hz�.zsy-�zs� <br /> CONTR.LICEN5E fl � <br /> USE OF BUILDING ( HEAT SO'JRCE ���y� CONTRACT PRICE OF WORK <br /> L;I�V_{SGf�L _Electric Gas_Other ( Z� �CJ� -' <br /> WORK DESCRIPTION <br /> c otilS�tlt�c.l"lo N oF f� Zo'�c zy � ���rlkcl�rp CzWIzWC� <br /> PLUMBlNG MECHANICAL <br /> NO. IYPE OF FIXTURE OR liC-M NO. TYPE OF FIXTURt OR ITEM <br /> Toilet A/C—air handling unils <br /> Bath�ub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kitchen sink&disposal Gas freplaco <br /> Dishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> Water healer Range hood <br /> Sink(service/badmop/etc.) Exhausl fan <br /> Backflow prevenler Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Retrigeralion <br /> Grease trao Woodslove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined:his application and know the samo ro be lrue and correct. All provisions oi laws and <br /> ordinaces goveming this type of work will be complied with Nhether specified herein or not The granting oi a permil does not presume <br /> to give aulhority to violale or cancei lhe provision of any other stale or local law regulaling construction or the performance ol <br /> consiruction.That I am aulhonzed by lhe owner of this property to pedorm the work(or which applicalion is made and I comply wilh the <br /> Slato Contractors Law 18 7 R�W and 296200 WAC. <br /> � <br /> � ��� i�� ��� /iJ-S-OG. <br /> ignaluro of Owner/ onlraclorlAulhon�ed Ac�enl Date <br /> �� 2 <br />