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PE� .�VIIT APPLICATIOI� <br /> CIl'Y OF EVERETT PERMIT SERVICES <br /> 320C CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-88 i 0- FAiC 425-257-8857-www.everettv.�a.org <br /> APPLICATIONS ARE ACCEPTED FROM 8.��M TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �f riv�+ r -(�"'� � � w Er�SlO -I(3 <br /> I.EGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AD�RESS CITY2IP PHONE <br /> jL� � I��L�'71l'l`:�I�L�_ <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> c'C."� ,�f- �-C.�. �Q,��T� <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> ��+ � {�'��N+34t.1�u;(�� �,,u�� � c.�ZS��IUs�y�i � <br /> CONTR.LICENSE# <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric Gas Other <br /> WORK DESCRIPTION <br /> '7571�`�T �Lctr?i�• <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—airhandling unils <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Back(low preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeral�on <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CI1Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this application and know lhe same lo be true and correct. All provisions of laws and <br /> ordinaces yoverning this type of work will be complied wilh whether specified herein or noL The granling of a permit does not presume <br /> � to give authoriry to violate or cancel the provision of any other slate or local law regulating conslruction or lhe performance of <br /> conslruction.That I am authorize�l by the owner of this property lo perform lhe work for which applicalion is made and I comply wilh lhe <br /> State C,onlract rs Law�1�8'17 R�W and 296.200 WAC. � <br /> _ - G� ,�/%�,�i�l��%/ /�%/�� <br /> Si�naW�e of Owner/Co t actof/ uthonzed Agent ale <br />