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; , <br /> , <br /> PEaMIT APPLi�•ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610–FAX A25-257-8857–www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /0 --1 —/D <br /> SITE ADDRESS PARCEL TAX I.D.# PER ���� �rD� <br /> �' �j(� //1' 7/ <br /> �S I )l CDI IC�' G I�VU <br /> LEGA LOTNO. BLO':K TRACTORSUBDIVISIONN �-o G 3 13 3s'�/�J <br /> oesc. C t'��c 1� G V�.z.l.� � o � "I I� �f G'�-� <br /> OWNER ADDRESS CITY2IP PHONE <br /> � <br /> �Qr��t � �I � � I �, � i��aNS�� r <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> �r�L�� E�AAIL <br /> �oe GH;S IC,���1�\ 2nc � I�C �/ ��J�S� <br /> CONTR.LICENSE M <br /> USE OF BUILDING / HEAT SOURCE CONTRACT PRICE OF WORK <br /> Y Electric _Gas_Olher � <br /> WORK DESCRIPTION <br /> . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet _ A�C–air handling units <br /> Bathlub _ Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Waler heater <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Water heater _ Range hood <br /> Sink(se�vice/bar/mop/etc.) _ Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeralio� <br /> Grease trap _ Woodslove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CO[lE IS 3105 <br /> I hereby certify that I have read and examined this application and know lhe same to be true and correct. All provisions of laws nnd <br /> ordinances governing this lype of work will be complied with whether specified herein or nol.The granting of a pertnit does not presume <br /> to give authority to vioiate or cancel the provision ot any olher state or local law regulaling construclian or the peAormance ot <br /> construction.That I am authorized by the owner of this properiy to pertorm the worlc tor which application is made and I comply with the <br /> Stale o tra ors Law 18.27 RCW and 296.200 WAC. <br /> / /� <br /> /�/ � `'�_� CC �- I . / t� <br /> ignature of Owner/Contractor/Authorized Agent Date <br />