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P�RMIT APPLICATICSN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—wvuw.everettwa.org <br /> I APPUCATIONS ARE ACCEPiED FROM 8 AM TO 4 PM �J � �� '�� <br /> SITE ADDRESS PARCEI_TAX I.D.# ��IT� � <br /> � 2 PiIV P.�.+� �/�� � � ` � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# __.—_.__-- <br /> DESC. <br /> p�R e � �� ADDRESS CITY2IP PHONE <br /> �� <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> E�MAIL <br /> R p .,e- � pQ <br /> CONTR.LICENSE# gp�l�ctlS � -�'t��%�Iz - /82�� ���S� � ���� ` aOf Z <br /> �l- �, -o g �Gi�o `3�5� GS- O <br /> USE OF BUILDING I — H AT SOURCE CONTRACT PRICE OF WORK <br /> Efectric _Gas_Other <br /> WORK DESCRIPTION � S - Z -I.t0.�- <br /> �� � � � (' ork- o►' 3 - ��oo� S i�V� <br /> � 1 K �JWt IL YGUU1�t 'W G <br /> .�'>��1-� l� � G<JCc�✓ �i�✓ 4� O1te- �jtniK <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXNRE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> = Water heater _ Range hood <br /> �_ Sink(service/bar/mop/etc.) _ Exhaustfan <br /> BackFlow preventer _ Heat purop <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> �i Floor drain _ Refrigeralion <br /> Grease lrap _ 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 lhis application an�i know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whethe� specified herein or not.The granting of a permit does not presume <br /> lo give aulhority t violale or cancel lhe provision of any olher state or local law regulaling construcdon or the performance of <br /> construclion.Thal am aulhorized by the owner of lhis property lo peAorm lhe work for which application is made and I comply wilh lhe <br /> Slale Conlractors w CW and 296.200 WAC. <br /> � �� <br /> Signalure o ctodAulhorized Agent e <br />