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� <br /> 1-ERMIT APP�.ICATIVN <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 �� ��s�� <br /> SITE ADDRE S PARCEL TAX I.D.p P RA�f�# <br /> 3��= � �0�6 � , hL �a� (� � io - �. <br /> J <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. ` �� �L- ��$ --o� <br /> OWNER ADORESS CITY2IP PHONE <br /> s p�=�k� <br /> �� rc k �.�.'J,r�y/c.' � /3a,1' /S �sr i�`.,v..-r_�`f- ydS -33o �1�73 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ��,l��na.�,d�ec. I <br /> 5�:,_.t._ ���.� n�'� E-MAIL <br /> Z(�Z` S%. v.,.� � R I <br /> CONTR.LICENSE M <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 0-(4', � - <br /> Eleclric �!Gas_Other I �,� ��:rp, "- <br /> WORK DESCRIPTION <br /> Gr��Y- ....�//i r d t�.r �cr b 5��� S'y -fs. c /�,�. T,L <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—air handling units <br /> _ Bath!ub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> _ Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> _ Clothes washer Clolhes dryer <br /> Waler heater Rango hood <br /> Sink(service/bar/mop/eta) Exhaust fan <br /> Back(low proventer Heat pump <br /> Urinal Unit heater <br /> Drinkiny Founlain Boiler <br /> Floor drain Retric�nrntion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAl(CODE IS�105 <br /> �hereby cerilify Ihat I have read and examined Ihis application and know the same to be lrue and correcL All provisions of laws and <br /> ordinaces governing this lype o(work will be complied with whether specified herein or nol.The granting of a permit does not presume <br /> to give authonty to violato or cancei lhe provision of an�•olher slate or iocal law regulating construction or the periormance of <br /> conslruclion. That I am aulhorized by Ihe owner of Ihis property tn pertorm Ihe work for which application is made and 1 comply with the <br /> Slale Conlraclors Law 18.27 RCW and 2P6.200 WAC. <br /> , ,, <br /> �' �./ ?J—, /D .3''�'b� <br />� Signalure of�ontraclor/Authonzed Agent Dale I/Z <br /> I <br />