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�icRMIT APPLICATI�JN , ��^ <br /> CITY OF EVERETT PERMIT SERVICES ,� i� � <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.evereriwa.org <br /> APPI.l::ATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRE�S PARCE4 TAX I.D./ PERMR N <br /> ��I�L( � V�ce.�� �/1/4 7�E� /�'1d�s 1� ' d�a <br /> LEGAL LOT N0. B OCK Ti2ACT /'Q�� �n <br /> DESC. (•�� '�r� <br /> OWNER ADDRE3S CITYQIP PHOME <br /> �i�r:.l0� g7� �q�S <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �11� ���' �e�.�G. Ta` ,�-o(,— 6�3 —�y�� <br /> CONTRACTOR /'� ADDRESS CITY IP PHONE <br /> Tvcu,t � 5�5' S. l.�aG.r St. .X� �'�3 K a-�G— '.�l—tsal <br /> CONTR.LICENSE M C�[ I`�E� ( S� � 7 � DL <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��t-q,v��-- _Electric �Gas_Other � ��c7 Q <br /> WORKDESCRIPTION ������ �� ���(�(�,�,� Ty'�t Hp.Z.^ y�yt�{�,y�� ����a�,�... <br /> �,�.� �l<�bi �p ,�;r� c� �1�� �vLr �✓ dc � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FU(TURE OR ITEM <br /> Toilel A/C—afr handling units <br /> Bathtub _J„_ Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Cbthes dryer <br /> Water heater � Range hood <br /> Sink(service/bar/mop/etc.) __�__ Exhaust fan <br /> Backflow preventer Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Boller <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicaGon and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governing this typo of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the pertortnance of <br /> construction.That I am authorized by the owner of this property to perfortn the work for which applicatlon is made and I comply with the <br /> State Contra aw 1 and 296.200 WAC. <br /> �, �� 1�3�� � <br /> S' ure wnedContraclodAulhorized Agenl Date <br /> �L <br />