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P�r2MIT APF�LICA_TiON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS I PARCEL TAX I.D.# I PER�# / <br /> f 3z �j DY �`� <br /> �LEGAL LOTN . BLOCK TRACT <br /> DSSC. <br /> OWNER AGDRESS CITY2IP PHONE .�6-3a�2 /2 <br /> C�,�vq✓eP.,,, �e�f'a-1 I_l�L��_��a �t � I�c,—�,�e �,a 9,°��� <br /> TENANT ME CONTACTFORPERMIT "HONe <br /> �Y�sf-o� ,�2,iq � �r c D,,,� � zr—Z��_o � ,^� <br /> CONTRACTOR S P�� n_� c ADDRES�/ CITY2IP PHONE <br /> � y ) J I J7�6 �29.1� AV� � �1�1Y � / <br /> CONTR.LICENSE# 2 �u 6-6 '�2 --Z 6 u,� <br /> Svtz-�s,���v�p �� � r <br /> USE OF BUILDING HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> _Electric _Gas_Other �� ,U U' <br /> WORK DESCRIPTION ' <br /> ��Cw�� ? (.e(�,.5 CrN l/GCe wc: <br /> PLUMBING , MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel AIC—air handling units <br /> Bathtub Porced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 tlisposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <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 cerilif�lhat I have read and examined this applic:�tion and know lhe same to be true and correct. All provislons of laws and <br /> ordinaces goveming this type of work will be complied w;� yhelher specified herein ar not.The granGng of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulatln�construction or the peAortnance of <br /> construclion.That I am authorized by the owner of this pro��erly lo perform the work for whlrh applicaGon is made and I wmply with the <br /> State Contraclors La�v 18�7 RCW and 296.200 WAC. <br /> . :__-�---� . ._- -- lr �z r—�� <br /> �__...___- <br /> Signature of Owner/Contrector/Authorized Agent Date <br />