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P-•ERMIT APPLICAT�vN -� <br /> CITY OF E'✓ERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—wwv�.evarPttwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADD ESS PARCEL TAX�.D.# PERMIT if <br /> ',�,,� i /� o0 5� �r�� oos oo�oo Mo��a - o�v <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/21P PHONE <br /> `�'l/1 f17"T ?3r)�Cl�J� S.� -�'-�''���`� � <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR /� � ADDRESS CITY2IP P!IOPIE r� 1 h � <br /> l9-��vL2-q�� ��L^ S ' vt. <br /> CONTR.LICENSE t! ,. � .�.� �'Z � <br /> vt=iv�SF� 37y10� C-P�� S �`A � �'k!!g �S�l�� <br /> USE OF BUILDING I HEAT SOJRCE CONTRACT PRICE OF WORK <br /> S � _Eleclric _Gas�Olher � 1 a���J <br /> 1_ <br /> WORK DESCRIPTION <br /> �--e�-1� �C.� &(.� y�1�,>.n� c-f' <br /> u <br /> PLUMBING ME:.HANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-•air handling units <br /> Balhtub �, For<:ed air systems <br /> Lavalory(wash besin) � Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mop/elc.) Exhausl fan <br /> Backflow preven;er Heal pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roo(drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y that I have read and examined lhis application and!cnow the same lo be true and correct. All provisions of laws and <br /> ordinaces goveming lhis type o(work will be complied wilh wh�lher specified herein or noL The granlin�of a permil does not presume <br /> to give e�lhority to violale or cancei lhe provision of any other slale or local law regulating construclion or the pedormance ot <br /> construcCon.Thal I am authorized\by Ihe owner of this property to per(orm the work(or which application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. / � / <br /> � C ' � n ( �� G� <br /> Signalure of OwnedContrector�ulhorized ont Dale � <br /> �`-. . . % <br /> , � ' <br />