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{ <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8C57 -www.everettwa.org <br /> APPLICATIONS ARE ACGEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �12� . S ' � .•� "� ' 00 1 Uvo Yl'� �io� - 3 � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �rnc' �S ��aNe. ?9� �7Y�n' i�u �� � J9( �/ .�/�v�.�C.>x4- 78�'V� h�ilz31-/y � <br /> TENANT NAME CONTACT FOR PERMIT PHONE ���_j/O �sl�7 <br /> t6 ''/ <br /> `� � �� /CNGI�., � E-MAIL <br /> CONTRA TO ICNCLGL � r]�.G f.PH� D�1/2� �� SGw.1�L �� Ig( �� 'ZO�+I��� �(�'�i <br /> CONTR.LICENSE# <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ElecUic Gas Other ���G� <br /> WORK DESCRIPTION <br /> C6��5?7�c �rcn `!� W�•(h rn ��cTU.P,�✓ <br /> PLUMEING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling unils <br /> � Bathlub Forced air syslems <br /> Lavatory (wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas rangc <br /> Clolhes washer Clolhes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backflow prevenler Heal pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain � Refrigeralion <br /> Grease lrap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y that I have read and examined lhis application and know lhe same lo be true and correct. All provisions o(laws and <br /> ordinaces governiny lhis rype of work will be complied wilh whelher specified herein or noL The granting of a permit does nol presume <br /> lo give authority to violate or cancel lhe provision of any olher slate or local law regulaling conslruclion or lhe performance of <br /> wnslruclion.Thal I am authorized by lhe owner of lhis property to perform lhe work for which application is made and I comply wilh the <br /> Slale Conlraclors Law 18.27 RCW and 296.200\NAC. <br /> / > /L�---��_ �f�/ 7/c �r <br /> Si9nalure of Owned ontfaclodAuthonz enl � <br />