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PEkMIT APPLICAl`ION <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 ,� G� �I - U=�-� <br /> SITE ADURESS PARCEL TAX I.D.# PE�! MITO�I/G�/ <br /> Si o� Ev�'���z�,�w� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZI� PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> l� e�-✓�- ✓f - CE.,��CR I �1oNN b'L�,r;�.�v as�-ySS-7s7� <br /> CONTRACTOR �%����5� To Ccr�•;r 3k; I.�IcfPDDRESS �S� c FN,✓;:vn,�TM21P PHONE <br /> ��Nc. <br /> CONTR.LICENSE# w���%�"H ��(�� ,�(�S—���5 <br /> C.��.sr C6o � 3R9 KS. <br /> USE OF BUILGING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Olher <br /> WORK DESCRIPTION <br /> �1 2-e D R��a.�e ��S3 c i1 E 13l�2 0 "^''S <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR I'i EM NO. Tl'PE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Balhtub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clolhes washer Clothes dryer <br /> VJaterheater Range hood <br /> Sink(service/bar/mop/elc.) Exhaust tan <br /> Backflow prevenler Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> � Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat I have read and examined Ihis application and!cnow the same lo be true and correct. All provisions of laws and <br /> ordinaces govemine� Ihis lype of work will be complied with whelher specified herein or nol.The granlinc�of a permil does not presume <br /> to give aulhority to violale or cancel the provision o(any other stale or local law regulating construction or the performance of <br /> construclion.Thal I am authorized by lhe owner of lhis propeAy to perform lhe work for which application is made and I comply wilh Ihe <br /> State Conlractors aw 18.27 RCW and 296.200 N;AC. <br /> .k1 � , . _ �j -�� <br /> ��,,��...�- �i <br /> Sig79lurebf Owner/Contraclor/Authorized Agenl Dale <br /> l� <br />