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PERMIT APPLICATION <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 O� ..'a�--� <br /> SITE ADDRESS ��� C�J(l�`�� PARCEL TAX I.D.# PERMIT p <br /> �v�� '-�- za c% 09- GZ' <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE �.�� <br /> {�f,� l�.�n� ��/�l�'���� ��e �i'��1 Gyr �b� ��� <br /> TENA— NT NpME� CONTACT FOR PERMIT PHONE <br /> E•MAIL <br /> ONTRACTOR E � P <br /> CONTR.LICENSE p �G��{/� � <br /> USE OF BUILDING I — HEAT SOURCE ( CONTRACT PRICE OF WORK � <br /> Eleclric Gas Other ��C� <br /> WORK DESCRIPTION <br /> �—,Jt�YLlC,�1' S� - - \ � , . t"1 �I � !�Ci � ,�. (lj,v' 'Y�' ��� r�l GGc,,..K <br /> PLUMBING ME HANICAL 3u 82 <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C–air handling units <br /> Balhtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Waler healer <br /> Kilchen sink&disposal _ Gas tireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/badmop/etc.) _ Exhaust fan <br /> B�ckflow prevenler _ Heat pump <br /> Urinal Ucil healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roo(drains Othor <br /> Olher - <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerilify that I have read and examined this applicalion and k�ow the same lo be true and correcL All provisions of laws and <br /> ordlnaces governing lhis lype of work will be complied with whelher specified herein or nol The grenling ot a permil does not presume <br /> lo give aulhorily lo violate or cancel the provision o(any olher state or Iocai law regulating consWction or lhe peAormance of <br /> conslruction.That I am a i d b the owner ot lhis property lo pertorm lhe work for which applicalion is made and I comply wilh lhe <br /> Stalc Conlradors Law 18.27 W and 2 . OD WA� <br /> ; __ � �l ��� �-, g <br /> i nature of-0t edConlractor/Authonzed Agenl Date <br /> I <br />