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� <br /> P'►r�MIT APPLICATIG .� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 322 C P-UvJ N p�- rn �q I I -v23 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE � 3� �- <br /> G—��U�Ca� C'�0-Pr(�T 322 cR-��t �2 ��� WA q� �2 <br /> TENANT NAME I CONTACT FOR PERh11T NE <br /> E•MAIL <br /> C NTRACT R A SS C I P ONE <br /> �w1"� <br /> CONTR.LICENSE# <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric Gas Olher �,J�� <br /> WORK DESCRIPTION <br /> (Zuh �a,o ��iPC -� �pp�1u n c.eS (,�'�rc��ac e $ Yan9e� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilc� � A�C-air handling unils <br /> 6alhlub Forced air syslems <br /> Lavatory pvash basin) �_ Gas piping <br /> Shower Water healer <br /> Kilchen sink& disposal . � ,� Gas(ireplace <br /> Dish�vasher _ � � Gas range <br /> Clolhes washer Clothes dryer <br /> Waler healer Rango hood <br /> Sink�scrvicelbadmop/cic.) _ Exhaust fan <br /> 6ackllow prevenler _ Heal pump <br /> Urinal Unit healer <br /> Drinkinc� Founlain _ Boiler <br /> Floor drain Re(rigeration <br /> Greasc trap _ Woodslove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify lhal I havet read and examined Ihis applicalion and know tho same lo be lrue and correcL All provisions of laws and <br /> ordinaces governing lhis type o(work will be complied with whelher specifiud herein or not.The grenling o(a permit does not presume <br /> to givo aulhorily to violale or cancel the provision of any olher sta�e or local law regulating construclion or the periormance ot <br /> construclion.That I am authorized by Ihe owner of lhis properly lo perform the work for which applicalion is made and I comply wilh the i <br /> State Contraclor Law 18.27 RCW and 299.200 WAC. I <br /> �� �l� l�,(n/�► I I ��3 f q i <br /> Signalure o Owner/ dra tor/Authonzed Agent Dale <br />