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PCRMIT APPLICATIf.�N <br /> CITY OF EVERETT PERMIT SEFtVICES <br /> 3200 CEDAR STREET, EVERETT, WA°d201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.urg <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � (�j S -0,�j <br /> SITE ADDRESS PARCEL TAX I.D.q pERMIT; D <br /> O Z �l�'Z I 1r M ' <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �i1�.P� soL.IJE/�vl �Z,S�tSt- o3G3 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> CONTRACTOR 1.��1N4P�C.6N{Sp�S-4}�q�n,C� ADDRESS '�.¢p.� G8{q �y� CITYRIP PHONE <br /> NL <br /> CONTR.LICENSE# /H��`�L� <br /> • • 9�•s�v-az3 <br /> USE OF BUILDING IiEAT SOURCE CONTRACT PRICE OF WORK <br /> _ElecUic�i as_Olher ?� // � <br /> — � 000 <br /> WO�QRIP-7'���� �fu"'w.""/Gt1�j�, � �`�7�''`T {;CLL_ <br /> �I U <br /> PLUMBING MECHANICAL <br /> NO. '.YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling unils <br /> Bathtub �_ Forced air systems <br /> Lavatory(wash basin) Z Gas piping <br /> Shower J_ Waterhealer <br /> Kilchen sink&disposal Gas firepl3ce <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/etc.) Exhaust(an <br /> Backflow prevenler Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeretion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y lhat 1 have read and examined lhis applicalion and know the same to be lrue and correct All provisions of laws and <br /> ordinaces goveming lhis type of w k will be complied wilh whether specified herein or noL The granting of a permit does not presume <br /> to give authorit violale or can el Ihe provision of any other slate or local law regulating consWction or the performance of <br /> construclio hat I aulhori d by owner of this property to perform the work for which appiication is made and I comply wilh the <br /> Stale raclors CW d G.200 WAC. <br /> � - ll-/s=oG <br /> Si alure of OwnedContractor thor.zed Agent Date <br />