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i <br /> PE�rtMIT APPLICATIO� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESSY�i�S ENzYcJrtrv� W� � PARCEL TAX I.D.# PERMIT# <br /> E,��tr uc� q go°►� So5 �3 -O� G <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNcR ADDRESS CITY2IP PHONE <br /> UOhin�S � ��g L VPA,�J/��N (X-v,J 1f � L�fU/ �O� � � <br /> TENANT NAME CONTACT FOR PERMR PHONE <br /> �i 5sc���..i ' �nct-�-S I Tev� d'�a Saal-4-32 -G'162 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CTCo/VST,qucTIGN 6'o2G /Ss$t� S� , SI.W LY�vNur.t�'o ✓� Zc�6' '}��1=G08� <br /> CONTR.LICENSE 11 CT[ONC y�J6pP 9 <br /> T lb - ll- �a�� �� J3Z <br /> USE OF BUILOiNG I HEAT SOURCE CONTRACT PRICE OF WORK <br /> I _ElecUic _Gas__Other I � %�j'� <br /> WORK DESCRIPTION <br /> � ��� <br /> PL.UMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR�TEM <br /> Toilet A/C-afr handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&dispesal _ Gas flreplace <br /> � Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry Vay _ Range hcod <br /> � Sink(servico/bar/mop/etc.) Exhaustfan <br /> Backflow preventer Heat pump <br /> Urinal Un(t heater <br /> Drinking Fountain Boller <br /> Floor drain Refigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> I CITY OF EVERETT LOCAL SALES 7AX CODE IS S10S <br /> II hereby ceritify that I have read and examined this applicatlon and know the same to be Vue and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not The grantlng of a pertnit does not;� 3sume <br /> to give authority to violate or cancel the provision of any other state or local law regulatlng consWctlon or the pertormance ot <br /> construction.That I am authorized by tho owner of this property to perform the work for which applfcadon ia mede and I comply with the <br /> State�ontracrors Law 1827 RCW nd 296.200 WAC. <br /> <��.�' � �'i�� __- cU3-7c(.-o � <br /> wcer/ContractodAuthonzed Agent at�e— <br /> �L <br />