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, <br /> P�tRMIT APPLICATIdN <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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ''� Erlef cx�AUP� C�er� BGs��-os <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PNONE <br /> TENANT NAME I CONTACT FOR PERMIi PHONE <br /> CONTRACTOR �.V uS 1 v�,Y-� ADDRESS � Q �Q�(' CITYIZIP i'HONE 3�_ <br /> CONTR.LICENSEa1�S��(C-t-1�1'1 . c�SZ MOY'�'OL'� ��_q-„� <br /> �E32�2 <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> C��r'�.1��5IV s"�'j1L(,I W'c.� _Electric _Gas_Olher <br /> WORK DESCRIPTION <br /> C-W �Ja�.� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTURE OR Il EM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Balhtub forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Wzter heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Laundry tray Range hood <br /> Sink(service/badmop/elc.) Exhausl fan <br /> Backflow prevenler Healpump <br /> Urinal U�it heater <br /> i _ Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Greaso lrap Woodstova <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined Ihis application and know tlie same to be�rue and correcl. All provisions of laws and <br /> ordinaces goveming Ihis type of work will be compliod wilh whether speci!ied herein or noL The granting of a permit does not presume <br /> to give authorily to viol or cancei the pro��ision of any othor state or local law regulating construction or the periormance of <br /> con Ir ion. t I aut orized by lho owner of this property to perform lhe work tor which application is made and I comply wilh the <br /> S te tracM s La 18 7 RCW and 296.200 WAC. <br /> r � <br /> t � c�---�----- �- 3 r-o, <br /> Sic�naWre of Ow r Contractor/Authorized Agent Date <br /> ��L <br />