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� <br /> PtRMIT APPLICATIUN <br /> CITY O� EVERETT PERMIT SERVICES f�.,., �;?� <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 TQ 4 PM <br /> SIiE ADDR�S nG'� � PARCEL TAX I.D.# PE IT�D��/� <br /> 'L7 2 �� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CINIZIP PHONE <br /> Jbo..h� �3v �kc4-�- POB l2s�U ����o �s��-3�z2 <br /> TENANT NAME CONiACT FOR pERM1T PMONE �2r) 7� 0�1(�2 <br /> L-C:.U�\?OL �4��R.. `��e'UC ��-g� E�A.OIL <br /> N R / <br /> A�AchP. ca��sa�ct,�,�n �a�� w ��;iuoe��. 2nc ��� ��42 <br /> CONTR.LICENSE p �,V��-�'L �✓ � 9QaZ�/�I <br /> CGC�71 A\I p.,ChC 1421 n P �n�7//� <br /> USE OF BUILD NG � HEAT SOURCE CONTRACT PRICE OF WORK <br /> �)��i,2�.�,r�— I �Elechic _Gas_Olher 2� QOC� <br /> 4// <br /> WORK DESCRIPTION <br /> ��� <br /> PLUMBING MECHANICAL <br /> NU. TYPE OF FIXTURE OR�TEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel NC-air handling imits <br /> 6athlub Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> � Kitchen sink 8 disposal Gas fireplace <br /> _ ishwasher 1: X rango <br /> C�W�ies washer Clot dryer <br /> WateTt ealer = Range h d <br /> � Sink(servi e/barAnop/otc.) _ Exhaust tan <br /> _ Backllow pr enter _ Heal pump ' <br /> Urinal Unit heater <br /> Dnnkinc� Founlain Boiler <br /> Floor drain Reirigeration <br /> Grease trap Woodstovo <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> I hereby ceritify lhal I havo read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordina�:es goveming this lypo of work wili be complied wilh whether specified herein or not.The granting of a permil does nol presume <br /> to c�ive authonty to violale or cancel the provision ol any other stale or local law regulating construclion or the pertormance nf <br />, construction.Thal I am authorized by lhe owner of Ihis property lo perform the work tor which applicatiun is made and I comply with the <br /> Sta�{� onlraclors Law 18.27 RCbV and 296.200 WAC. <br /> V � � 'il\q� ��1���1'�: !�W/'� I <br /> aignalure of OwnedContractodAuthorized Agenl Date `� <br /> '� � <br /> � <br />