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�:-�, <br /> PE IT APPL�CATIOI� �� �`� <br /> , � �, , <br /> , , . <br /> CITY OF EVERETT PERi1AIT SERVICES '�1 �" <br /> 3200 CEDAR STREET, EVERET�,VVA 98201 <br /> 425-257-6810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ���{ �1F7 08 OD S <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT/ <br /> I0611 rc✓ reert Inr� Sa�c,ff'� .z <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��P.�n No-n� lo6i� E���,j-.�.� S. <br /> TENANTNAME CONTACTFORPERM PHONE <br /> � (�r vt H Un� I J-�..rem� k 2S �.�-o � S6 �/ <br /> CONTRACTOR (/1/G Q P GCI'1'f (K9 ADDRESS ��321 1Yf S¢ Se CITY2IP PHONELO � <br /> s- s ry9a�a j `l <br /> CONTR.UCENSE# wo�.�e � �3� h'«r►*oe 8 6 2 1 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Dr L �� ' _Electric _Gas_Other <br /> WORK DESCRIPTION SKPp�� LtlA tif^ SCf(/I CB� �� �� �PBP � Zn p�'�O"r' <br /> V�iosL b;b . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE 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 /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhos washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mopletc.) Exhaust fan <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains�Q�6�� = omer <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerilify lhat I have read and examined this applicaGon and know lhe seme to be true and cortect. All Frovisions of laws and <br /> ordinaces governing this type of work will complied with whether specified herein or not.The granting of a pertnil does not presume <br /> to give authority to violate or cancel the rovi lon of any other state or local law regulating consWcUon or the performance of <br /> construclion.That I am authorized by th owner of this property to perform the work/or which applicaGon is made and I comply with the <br /> Contractors Law 18.27 RCW and �6200 AC. <br /> ' f2 - Zl - od <br /> ure o OwnedContracrodAulhorized Agent Date <br />