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PE�MIT APPLICATIOIS � ' ,�,� <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT,WA 98201 I�I <br /> 425-257-8810-FAX 425-257-8857-www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT A <br /> r � , , �' E���z����.N ��a a � I s �/�-Zs <br /> LE LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE33 CITY2IP PHONE <br /> TENANTNAME CONTACTPORPERMIT PHONE <br /> R.I P=a1�`�-�oN �s ���E-�� <br /> CONTRACTOR , '.f��' /U'Yc- � � ADDRESS CiTY21P PHONE <br /> CONTR.LICENSE k <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric Gas Other `��� <br /> WORK DESCRIPTION <br /> V`-�(/�./� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handl(ng units <br /> Bathtub Forced air systems <br /> Lavatory(wash b2sin) Gas piping <br /> Shower Waler heater <br /> Kilchen sink&disposal � Gas fireplace <br /> Dishwasher Gas range <br /> Cbthes washer Clothee dryer <br /> Water heater Raoge hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backtlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boller <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> I hereby ceritify that I have read and examined this application and know the same to be Uue and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or nol.The granting of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other stale er local law regulating construcUon or the performance of <br /> construction.T t I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contract rs R and 296.200 WAC. <br /> C' , o a <br /> nature of wnedCo tractodAuthorized Agent Da <br /> I�� <br />