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PEkMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- ��AX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � --a9 -c� <br /> SITE ADDRES PARCEL TAX I.D.# P MIT p <br /> �SI �GnY�vE i�l �% �S' �' <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> FG M ���re� �814C'o�c���jve ��F 98�t (4�5� 445-55�3 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ,S'erQe� f�ovi i�bv (4�5)445-g5�3 <br /> CONTRACTORO� �R� ���S �� �nN�CITYIZIP PHONE <br /> vuvL <br /> CONTR.LICENSE fl <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other �5vt� <br /> WORK DESGRIPTION <br /> Ne� o{�icz sP�Q2S <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handiing unils <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhausl fan <br /> 8ack0ow preventer _ Heat pump <br /> Urinai Unil heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY Of EVERETT LOCAL SALES TAX CODE IS 3705 <br /> i hereby cerili(y that I have read and examined Ihis appticalion and know Uie same to be true and correcL All provisions of laws and <br /> ordinaces goveming this rype o(work will be complied with whether specified horein or noL The granting of a permit does not presume <br /> to give authonly to violato or cancel the provision ot any other slate or loral law regulating construction or the pedormance ot <br /> construction.Thal I am authorized by lhe ovmer of this property to perTorm the work tor which application is made and I comply with the <br /> State Conlraclors Law 1 RCW and 296.200 WAC. <br /> ERCxEY 11�7vir�cu ) O6-�S-W' <br /> SignaWre o(Ow nlraclodAulhonzed Agent Date //Z <br />