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Y <br /> PEr2MIT APPLICATION <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 <br /> SITE ADDRESS PARCE'_TAX I.D.t� PERMIT# <br /> � 17 �30 C_VaJ,��cU1.J 5 g/� — �� <br /> EGAL LOT NO. BLOC TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ��8��� <br /> TENANT NAME CONTACT FOR PERM PHOIvE <br /> /��� �(^ An2/ . �� �` ��iC.n�c��uo�Bti E.MAIL I�S�-�-AN�R�I�'Grt1A+l� M� <br /> v� b \ <br /> �FTRACTOR . ADDRE - ITYIZIP <br /> CONTR. LICENSE# �`La � <br /> I USE OF BUILDING HEAT SOURCE CONTRACT PRICE UF WORK <br /> Eleciric Gas Other <br /> WORK DESCRIPTION . <br /> j,:�',�� ,��4 �c�-i� .Gvc-u ,G�ci/� <br /> , � <br /> PLUMSING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air har�dling units <br /> Ba1hWb � � Forced air systems <br /> Lavatory (wash basin) Gas piping <br /> Shower Wa(er healer <br /> Kilchen sink&disposal � , Gas fireptace <br /> Dishwasher Gas range <br /> Clolhes washer . CIoU;es dryer <br /> Water heater Range hood <br /> Sink(service/badmop/elc.) Exhaust fan <br /> �ack0ow preventer Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigera�ion <br /> Grease trap Woodstove <br /> Roo(drains Other <br /> O�her <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hemby certify iha� I have read and examined ihis applica6on and know the same to be true and correct. All provisions ot Isws and <br /> ord�nances governing�his type of work will be complied with whether specified herein or not.The granting of a permit does not presun:e <br /> to give aulhoriry to violate or cancel/he provision of any olher state or loca�law regulaling construction or the performance of <br /> consiruction.That I am authorized by the owner of ihis property to perform the work(or which application is made and I compty with�h� <br /> State Coniraclors w 18. 7 RCW and 296.200 WAC. <br /> �-� C���-W ial is)oq <br /> �QignaWre o(Own C-on r dodAuthorized Agen� D�IeT <br /> / ` 1I1 <br />