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P�RMIT APPLICATI�N ���j�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� <br /> SITE DRESS� PARCEL TAX I.D.N PERMIT N <br /> I 2 � ��C-n�� A � - D -D z <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER I ADDRESSl CITY2IP PHONE <br /> �� AUL I �1 1 I� � 7� � �iC ��T��hJN T� <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> CONTRACTOR � L i I �q n r/ ��I`p.L�DRES3 CITY2IP PHONE 3�0 757�y y <br /> Q � ���IG1. n , , �J�,I ,�,� _ ,��. v�.N�N <br /> CONTR.LICENSE N I 1 ,� /J, ,y��7 -�7�J <br /> W l.7 p L / I <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric Gas Other <br /> WORK DESCRlPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXiURE OR ITEM <br /> Toilet A/C—air handling units <br /> � Bathtub _ Forced air systems <br /> _� Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backilow prevenler _ Heat pw7p <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> � Roof d��A n �, _ Other <br /> Other / ��{Yl �=� If �s <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing lhis type of work will be compiied with whether spec�ed herein or nol.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 r.egulating construcUon or the performance of <br /> construction.Ihat I�maatho�ized by the owner of this property lo perform lhe work for which applicaGon is made and I comply with the <br /> StaSe Contracto aw 18.27 RCW and 296.200 WAC. � <br /> �� � /� .�'ZG� � ��` <br /> ign of Ow � r ed Agent Date <br /> l <br />