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P��RMIT APPLICATIC��V <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 PARCEL TAX I.D.# PERMIT# <br /> 4so2 fa�srn,wr� oo4q�oo2ooqoo '� - �3 <br /> LEGAL LOT NO. . BLOCK TRACT OR SUBDIVISION# r <br /> DESC. <br /> OWNER . ADDRESS CITY2IP PHONE <br /> DurS,rvrors ��r{tierun C�uvel, 2�S ,ykki/�o ,g/�d �/��fi` 98?03 425.Zsa.a4i3 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> E•MAIL <br /> R C �1,,h� <br /> W <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 9A��a9e _Electric _Gas_Other <br /> WORK DESCRIPTION <br /> �Mo�a�lnr� o� O�o� 9arq'G�ShEG� <br /> PLUME3ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Ba�htub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal . Gas fireplace <br /> Dishwasher • Gas range <br /> Clothes washer . Clothes dryer <br /> Water heater Range hood <br /> Sink(service/barlmop/etc.) Exhaust fan <br /> BackOow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease Irap Woodstove <br /> Rooi drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and cxamined this applicalion and know the same to be irue and corred. All provisions ot laws and <br /> ordi s governing this type of worl will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to ive au onty to violate w cancel ihe provision oi any other state or local law regulating construction or the perfortnance ot <br /> c nstrucli n.That I am authorized by th�owner of ihis property to peAorm ihe work for which application is made and I comply with ihe <br /> S e Co ractors Law 8 C a 6.200 WAC. <br /> U� -OQ- CD <br /> Wr o wn dC ntrac o uth i d Agent Date <br />