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PEI .i�lIT APP�ICATIOh <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREcT, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> 2 —�3 —�6 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> /S�ITE ADDRES� / ' �/ y�'�`'�� PARCEL TAX I.D.# P�MIT# <br /> 70���� /.'J-C�c'N�✓'✓GCJ.dG� Fl�E�cl`'i' C�Oc� <br /> IEGA! LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER A�DRE55- CITY2IP PHONE <br /> {�� P U�/•n i.� C=>US S�N ��e�.�j0 �yfli�� /(/� ��Nn�O.P� JvA 9�'c�.� �/�-�'-5 7Sy l�s- <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> I�21!/C?NQ �CL!'"G/ 6JrZ� �/',�:-�- 7.5� - 7`�7J� <br /> CJNItv��TGk i�DDRE53 CITYP�P P40NE <br /> CONTR.LICENSE!1 <br /> ! '.�� �� � <br /> USE OF BUILDING � tiEAT SOURCE CONTRACT PRICE OF WORK <br /> � ,C/� �Electric _Gas_Other <br /> / / <br /> WORK DESCRIPTION <br /> �,�� /�l'/��' � <br /> /" <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower W ater heatzr <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer Clothes dryer <br /> I _ Laundry Vay = Range hood <br /> Sink(service/bar/mopletc.) Exhaust fan <br /> ! Backflow preventer Heat pump <br /> i = Urinal = Unit heater <br /> Drinking Fountain �3oiler <br /> Floor drain Refrigeration <br /> Grease trap Woodatove <br /> Roofdr ns Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i I hereby cerilify that I have read and examined this application and know the same to be true and rorrect. All provisions of laws and <br /> ordinaces goveming lhis rype of.work will be complied with whelher speciiied herein or ncL The granting of a permit d�es not presume <br /> Ito give authonty to violate or cancel the provision of any other state or local law regulating construcUon or the performance of <br /> construction. That I am authorized by the owner of this property to perform the work for which application is made and I compiy with the <br /> State Contre tor Law 18.27 RCW and 296.200 WAC. <br /> , <br /> ��c-�'yCr �� o?- �'�- e� <br /> Signature of OwnedContractor;Authonzed Agent Date �/Z . . <br /> � <br />