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� cRMIT APPLICATI.�N � <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 /> (aD�� 4PPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � - a�j -/� <br /> SITE ADDRESS ,F� PARCEL TAX I.D.# P MIT q <br /> i n <br /> r�. . � ;- C<,,- �f 1'JJ R /OG2 -G/,3 <br /> LEGAL LOT NO. DLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �tl �� � .��/P S S d�C` �S D � .� �� /� � � L✓� �i.I/1_ l�J``)- �- ,�' I <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> '> � E <br /> ��' � E J����:�..�r �a� (4-��MA�� � � �- o <br /> TR T R y'� D S TYIZIP P <br /> 1,/ C(�1�2.l19 C�/l�e. <br /> CONTR. LICENSE M �� „ � � G �� �� /� ^ i <br /> �� L` �� <br /> 1 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I _Eleclric _Gas_Olher ��.51�Q,jg — I <br /> WOR!( DESCRIPTION I <br /> lU��cU {��u sC; ' <br /> � <br /> I PLUMBING MECHANICAL I <br /> 1 NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM i <br /> � ,� Toilc� NC-air handling units � <br /> � Balhtub Forced air systems I <br /> � Lavatory(wash basin) � Gas piping <br /> Shower � Water heater � <br /> Z Kitchen sink& disposal � Gas fireplace I <br /> � Dishwasher _ Gasrange I <br /> �_ Clothes washer Clothes dryer <br /> _ Water heater � Range hood <br /> _ Sink (service/bar/mop/elcJ !-�' Exhaust lan <br /> , Backllow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> _ Floor dram Relrigeration <br /> Grease lrap Woodslove <br /> Roof drains Olher <br /> Other <br /> . CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> i hereby ceAi(y Ihat I have read and examined ihis application and know the same to be lrue and correct. All provisions of laws and <br /> ordmances governing this lype of work will be complied with whether specifed herein or not.The granting of a permit does no�presume <br /> lo give au�horily to viola�e or cancel the provision of any other state or local law regulating consirucUon or the periormance of <br /> construction. That I am authorized by the owner of this property ro peAorm the work for which application is made and I comply with ihe <br /> S�ate Contractors Law 1827 RCW and 2�J6200 W�C. <br /> �.:i C L/ �./i�/�G � ' / � � � '' �d <br /> I Signature ol O�vnedContractor/Authorize Agent Date <br /> _ _ — __ — -- - -- -- - - I-�- I <br /> L� <br />