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� � <br /> PERMIT APPLICATION <br /> CITY OF E�'ERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 4 5-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED F �A1N TO 4 P - EBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS ' I �U � PARCEL TAX I.D.# P RMIT��_� <br /> CJ <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS C!TYIZIP PHONE <br /> Lv���l L�VeId�Pr1�n� �� N, ��N�d gi�a � I��d�ie, G� q � zo3 <br /> TENANT NAME CONTACT FOR PERMIT PH�NE <br /> � bv S IGGo lov✓� �4-1 k�� 11ULj <br /> CONTRACTOR ��A�/f,U'� �WI/J{/C�f'f�/h ADDRESS �L •S• CITY/ZIP PHONE <br /> ! / �J <br /> CONTR.LICENSE# �,/�� !//f /�� �f/j� C�'�/� '��ji — 7G7�1�y <br /> � f7�G li'1 —1 V ) <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Eleclric _Gas__O�her �2 ' <br /> WORK DESCRIPTION <br /> (i S) D� �S°�S , �3) ���"r�'��}�r'W'S <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Todel _ A/C—airhandlin3units <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) _, Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher G�s range <br /> Clothes washer _ +Ihes dryer <br /> Laundry trey _ ge hood <br /> Sin!;(service/badmop/elc.) _ �ust(an <br /> Backf!ow orevenler �I pump <br /> Urinal �nit nealer <br /> Drinkinc� Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correcL All provisions of laws and <br /> ordinaces oveming this type of work will be complied with whelher specified herein or noL The grenting of a permil does nol presume <br /> to give au rity to violate or cancel the provision of any other state or local law rec�ulaling conslrudion or lhe pedormance of <br /> wnstructi .Thal I am authorized by the owner of lhis propedy to perform lhe work for which applicalion is made and I comply with the <br /> � State Cont ct rs Law RCW and 296200 WAC. <br /> LI O <br /> Signatur mer/Co clor/Authorized Agent Date I <br />