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r <br /> PERMIT APPLICATION <br /> CITY OF �V�RETT F�ERMIT SERVICES <br /> 3200 CEDAR STREE'!, EVERETT,WA 98201 G--�jJ-�� <br /> 425-257-8810— FAX 425-�57-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ;o9�v Ev��F�J u.� I o��`�a��3oa�Z n_�s�a6�� � <br /> LEGAL LOT NO. BLOCK I TRACT OR SUBDIVISION# <br /> DESC� <br /> OWNER NDDRESS CITYIZIP PHONE <br /> l09�o �'v����J u�� Ev�� <br /> TENANT NAh7E I CONTACT FOR PERMIT PHONE <br /> �3Eo�s9-c�910 <br /> f�'._.ITl�G,� r/o7s?� c1��,� _ Sl�NT e-Ma� <br /> CONTRACI•" �ADDR S � � <br /> W/tC_(«.: - C�CXS'�TZD1�l �-.:-?' ;i7�TE iF✓� 57��� Et/Y�tT �J� <br /> CONTR.LICENSE# 36���`��'�� <br /> USE OF BUILDING � HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Elec:ric Gas__Other <br /> WORKDESCRIPTION ��y�.j�lSH" V�F�� �w�'���� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A�C-air handling units <br /> BathWb _ Forcedairsyslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shnwer _ Waler heater <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clolhes dryer <br /> Waler heater _ Range hood <br /> Sink(servic�/badmop/etc.) _ Exhaust tan <br /> Backflow prev�nter _ Heat pump <br /> Urinal _ Unit healer <br /> Drinkinc� Founlain _ Boiler <br /> Floor drain __ Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ Olher <br /> Olhar — <br /> —I <br /> CITY OP EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceri;ii�+that I have read and examined this application and know the same to be true and correcl. All proviswns of laws and <br /> ordinaces governing this lype of work will be complied with whelher specified herein or nol.The granting of a permit does nol presume <br /> to give aulhoriry to violate or cancel the provision of any other slale or Iocal law regulating construction or lhe performance of <br /> conslruclion.That I am aulhorized by the owner of this property to pedorm lhe work for which applicalion is made and I comply with lhe <br /> Stale Conlractors Law 18.27 RCW and 296.200 WAC. <br /> �.�� � -�-1`��-- (—�-C'� _ <br /> naWre of Owner/Conlractor/Authorized Ageni Date \ <br /> L�-- \�� <br />