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F�RMIT APPLICATII,N <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 � 36—O� <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT# <br /> p� 30 L�FR(,�t�lu W oS .S��DO��z� /`{a� _ CS7o7 - �' <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OVlNER ADDRESS CITYIZIP PHONE O� Zp1 <br /> � l NE No� POn uT tc.� � a� t vPPe,�- �-��y� r�-n �J�r� Zr_ <br /> TENANTNAME CONTACTFORPERMIT ONE <br /> _Zi�M ZA� �nr��• Q���T t=l�az a�rtE�h �:;;°�3s4 Y2� q 4s <br /> CONTRACTOR ADDRESS CITYIZIP PHUNE <br /> 0�N2'�-- <br /> CONTR. LICENSE# / / �� <br /> �� <br /> USE OF BUILDING `'V ti HEAT SOURCE CON�CT PRICE OF WOIiK <br /> � ����E dF u s E ra �rE�«'�r`Electric _Gas_Othcr I ,S �� <br /> WORK DESCRIPTION <br /> PLUM8ING MECfIANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> 6athtub Forced air syslems <br /> Lavatory(�vash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer C�othes dryer <br /> Waler healer Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeration <br /> Grease lrap Woodslove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify lhat I have read and examined lhis application and know lhe same to be true and correct. All provisions of Iaws and <br /> ordinaces goveming this lype of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violale or cancel the provision of any other slale or local law regulaling consWclion or the performance of <br /> construction.That I am authorized by the owner of Ihis property to perform the work for which application is made and I comply with the <br /> State Conlraclors Law 1827 RCW and 2 6.200 WAC. <br /> ���.,,.��,� . ��s4 ?- i a- a� <br /> Signalure of OwnedConUac odAulhorized Agenl Date <br /> lL <br />