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PtRMIT APPLICATIGN <br /> CITY UF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACC�oTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.C.# PERMI7 p <br /> �-i�31 ��„�,.,o,� A.�� ��9/� v - ��/ <br /> LEGAI LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �,.,.,,,� \4u�S�ur Su�r-�- ��paS�3S= -3`180 <br /> TENANiNAME I CONTACTFORPERMIT PHONE <br /> I E-MAIL <br /> NTRACT R C ADORES —�TY21P NE <br /> CONTR.LICEN���^ ` `�'1^� <br /> ,�/y1�'� �Z �i�/,;1 LT <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �4-5 I _Electric �Gas_Olher <br /> WORK DEbCRIPTION \!� . <br /> 1 <br /> a �>,�ti ,�'a c-� <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A!C'�–air handling units <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) � Gas piping <br /> Shower W aler heater <br /> Kitr,hen sink 8 disposal � Gas fireplace <br /> Dishwasher Gas range <br /> ^ Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/barlmopletc.) _ Exhaust fan <br /> Back(low prevenler Heal pump <br /> Urinal Unil healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap _ Woodslove <br /> Roof drains Other <br /> Olher <br /> _I <br /> CITY OF EVL•RETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined lhis appiicalinn and know the same to be truc and wrrecl. AII provisions of laws and <br /> ordinaces governing lhis type of work will be complied with��heUier specified herein or noL The granling of a permit does nol presume <br /> lo give authority to violate or cancel the provision of any olhor stale or local law regulating cons;ruction or Ihe pedormance of <br /> construclion.That I am aulhorized by lhe owner of this property to pedorm tho work for which application is made and I comply with the <br /> Stale Conlractors Law 1827 R�W and 296.2UO WAC. <br /> �-a�� Col a-�ol ��1 <br /> Signalure of OwnedConlractor/Authorized Agent ate <br />