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PERMIT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.arg �,�+ <br /> �1 -3� -�/ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> � <br /> SITE ADDRESS PARCEL TAX I.D.il PERMIT� <br /> ;.��-I�J ���lb�.. �.�lx� ���C"� � .�- ,c ,�'- cz��' <br /> LEGAL LOT NO. �--� BLOCK TRACT OR SUBDIVISION A <br /> DESC. <br /> OWNER ADDRE55 CITY/ZIP PHONE <br /> �a a�-33�-`i��S4 <br /> ��SSl��,.,--5--�-e�50 Y� :�`-('�3 5 L�lb� r�r �'Cc�I <br /> TENANT NAME CONTACT fOR PERtdIT PHONE <br /> E•MAIL <br /> CONTRACTOR ADD S CITYlZ P HONE <br /> �1,�_.r..s�..-'^ r�r1S-x;..��cc`� :���✓�It1�Y"� r�fLr�l� ':�>`�,. 'J3c�- -If� � � <br /> CONTR.LICENSE# � � <br /> � <br /> l.r,'�?,� f��.��C QLC� , -�'rl���'��`� �l�Y{ b��� 3 <br /> USE OF BUILDING I � HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���� _Electric _Gas__Olher <br /> WORK DESCRIPTION <br /> ;.,�:i-er I�eo'fe.�- a- �����c.c� C�,s►c�_�is�� �.- <br /> :%�C�,._,,.�. �aF +U�+�tc �'��S) , at <br /> � - <br /> (7 ;� 1,:�C;b`��n. r <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIX�fURE OR ITEM <br /> Toilet FVC-a�� iiandlinc� units <br /> Balhlub Forced air syslems <br /> Lavalory(wasli 6asin) _ Gas piping <br /> Sho�ver lNaler heater <br /> I<itchen sink&disposal _ Gas fireplace <br /> Dishwashcr Gas rangc <br /> ( Clothes washer Clolhes dryer <br /> t Waler heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhausl fan <br /> Backtlow preventer _ Heal pump <br /> Urinal Unil healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woo�slove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined Ihis application and know the same to be true and corre.�. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whelher specified herein or not.Tho granting of a permit does not presume <br /> to give aulhorily to violale or cancel the provision o(any other state or local law regulating construclion or the performance of <br /> conslruction.Tha!I am aulhorized by Ihe owner of lhis property lo perform lhe work for which app�ication is made and I comply with the <br /> Sfat Contraclors,Lac9l�7 and 296.200 WAC. <br /> l l <br /> � .-c:�3� �'� ' J <br /> S�g uro o(OwnedContractor/Authonzed Agent Dato <br />