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P�RMIT APPLICATIC.nI <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 g�9�-GJ <br /> / <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 7/ G o0 9�� oG � CD� 4.� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PF10NE <br /> �!/��c;�c,�,prC/' �dso-✓n�v��,�D /7i7 �Urro.�J 1fv,�XTr9�loi `Jzs-�-.i 70�' <br /> TENANTNAME CONTACTFORPERMIT PHONE (�ZS�4`�fp.,S76� <br /> .3'�� b•�Ns2 �,tA.n�ti e.Ma� <br /> R RE I H NE <br /> G�w�v�'2 <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ,��LS/dJf�f/lf S/A!4(� F/avh. �Eiectric _Gas_Other ��L��G� <br /> WORK DESCRIPTION <br /> � /� / � _ � Qy�� �p/��OrJ i� <br /> ����1 ��f—. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> /� � Toile� _ AIC—air handling unils <br /> Oatlitub Forced air systems <br /> / �C lavalory (wash basin) _ Gas piping <br /> �( Shower _ Water healer <br /> Kilchen sink 8 disposal Gas freplace <br /> Dishwasher � Gasrange <br /> / _,� Clothes washer � Cbthes dryer <br /> Water healer Range hood <br /> / � Sink(service/baAmop/elc.) ,� Exhausl fan <br /> Backflow preventer Heal pump <br /> Urinal Unil healer <br /> Drinking Founlain Boiler <br /> Floor drain Re(rigeralion <br /> Grease trap Woodslove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y thal I have read and examined this applicalion and know Ihe same to be true and correcl All provisions of laws and <br /> ordinaces governing this type of work�vill be complied wilh whelher speci(ied herein or noi.The granting of a permil does nol presume <br /> lo c�ive authority to violale or cancel lhe provision of any olher stale or local law regulatin9 consiruction or the performance o( <br /> construc�ion.That I am au�horized by lhe owner of lhis property lo periorm lhe work tor whir.h application is made and i compty wilh lhe <br /> Slate Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> St��2 ,� `1�i2n'rzr�v �L� n� <br /> Signalure o(OwnedConlractodAulhorized Agent Dale l <br /> �Z <br />