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PtRMIT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �I I 'b �� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT l� <br /> � �o a ������� sT ��c,�- , � ��, 3s�,�o i o0 0 �o � -�0 2 <br /> LEGAL LOT NO. B (Q�C,K TRACT OR SUBDIVISION# <br /> DESC. S Z 3�"" <br /> OWNER ADDRESS CITYIZIP PHONE <br /> Dov��r�s P��p�zIDCPL �i3�( T2i���E bwk5 02 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> C.ENTUR- p�I NOI�NC''� S I E•MAIL _ <br /> �O-1� OR ADDRESS �� � N <br /> ��E- �PtU�L S�ilvicF;, �J.�'�-X.''' ;r n��.l,� SRWttt'Y1�9 u,4t- �-h Z5 �335'73(7 <br /> CONTR.UCENSE# <br /> }-}o1�c 2�ZS`r U �� Z - <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> `�� <br /> �������� _Electric _Gas_Other �S ���� <br /> WORK DESCRIPTION <br /> �Z v�� ��,1;��-e1 <br /> PLUMBING MECIiANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM ' <br /> 1'oilet _ A/C-air handling unils <br /> Bathlub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ \Naler healer <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/badmop/etc.) _ Exhaust tan <br /> Backflu�v preventer _ Heat pump <br /> Urinal _ Unil healer <br /> Drinkinc� Founlain _ Boiler <br /> Floor drain Re(rigeralion <br /> Grease lrap _ Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereliy ceri;ify lhat I have read and examined this application and kno�v the same lo be lrue and correcL All provisions of Iaws and <br /> ordinaces governing this lype o(work will be complied wilh whether specified herein or noL The granling of a permit does nol presume <br /> to c�ive authonty to violale or cancel lho provision of any other stale or local law regulating construclion or the peAormance of <br /> conslruction.That I am authorized by lhe owner o(this property to periorm the work for which application is made and I comply with lhe <br /> State Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> ,�/.��,� - �! ��//��'J _ <br /> SI'gnalure oF OwnedContr lor/Aulhonzed Agenl ' ate <br />