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PERMIT APPLICATION <br /> CITY OF EVERETT PERIVIfT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org / � ..'a.l{ . O� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM Pw ��a - cr�� <br /> SI7E ADDRESS .��3� (''(J�/ .�diU.�U� I PARCEL TAX I.D.# PER IT p _� <br /> Ev�sr wR ��SZv; / <br /> iEGA LOT N0. BLOLK TRACT OR SUBDIVISION# <br /> DESC. p �/L,.f.f.� N,(L�f�.'� . <br /> OWNER ADORESS CITY2IP PHONE (�,ZS-ZIO � <br /> SA�ziJA Sq�G.� y�3G Gc%3y-d�e•�iUt FG�ii Iv,a 93�03 �4z2 <br /> TENANTNAME CONTACTFOR PCRMIT PHON[ <br /> E•MAIL <br /> RAC RE S I Y7 IP <br /> CONTR.LICENSE A D✓� ��� <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���( � G� ,_Eleclric _Gas_Olher <br /> WORK DESCRIPTION <br /> �i�.4T(C/-/G/� C Ae/kG�c= <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> Toilel A/C-air handling units <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range � <br /> Clolhes washer Clolhes dryer <br /> Waler heater Range hood <br /> Sink(servico/badmop/elc.) Exhaust fan <br /> Backflow prevenler Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Greaso lrap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAI SALES TAX CODE IS�105 <br /> I hareby cenlify thal I have read and examin-d this applicalion and know Ihe same to be We and correcl. All provisions of laws and <br /> ordinaces governing this type o(work will be complied wilh whether specified herein or not.The granting of a permif does not presume <br /> to give authority lo violate or cancel the pmvision of any other staie or local law regu�ating construction or Ihe periormance of <br /> construclion.Thal I am aulhorized by lhe owner o!this property to pedorm lhe work tor which application is ma:',e and I comply with the <br /> Stale Contractors Law 18.27 RCW and?98.200 WAC. <br /> �;• a :� �i� 3-O�` <br /> Signa ire ot wn r antraclodAuthorized Agenl Date <br /> � <br /> � i <br />