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PtRMIT APPLiCATIUN <br /> CITY OF EVER�TT 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 '�y l,��Q 7 <br /> SITE ADORESS PARCEL TAX I.D.# P�RM� � <br /> .(� 40 Go�SY ({✓F �✓�2ET" / � Z_ <br /> ( <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYlZIP PHONE <br /> �._ suE c.er- .z�G -BiG -zG7y <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �oYF�L �ouTi4'vC LLL /E� �ACNT� y�•�-?;9- 5��3G <br /> CONTRACTOR t ADD ESS CITY2IP PHONE <br /> CONTR.UCENSE It V 1 �� (�S� <br /> ( ✓ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric '�Gas_Other S y d'cu.�� <br /> WORK DESCRIPlION <br /> �'�v�=7Jr' lMI�1;�It�YC�"%. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> z Toilcl NC—air handling unils <br /> Bathtub Forcetl air systoms <br /> / Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/etcJ Exhaust fan <br /> Backflow prevenler Heal pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof draine Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritily thal I havo read and examined this applicalion and know the same to be true and correct. All provisions o(laws and <br /> ordinaces governing this type of work wil�bo complied with whelher specified herein nr not.The granting of a permit does not presume ' <br /> to give aulhonry lo violate or cancel the provision of any other state or local law regulating construclion or the performance of <br /> consWclion.Thal I am aulhorized by the owner of Ihis property to pedorm the wrork for which application is made and I comply with the <br /> Stale Contractors Law 1f3.27 RCW and 296.200 N'AC. <br /> Tc� �czci,.ra �j-�4-v7 <br /> Signalure o(O�vnedConlraclor/Aulhorized Agent Oate <br />