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PErLMIT APPLICATIOIv <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, Vl A 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S �-)6 -d� <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT fl <br /> ' ��'n ✓�e, DO `f�v 'f'�0 U DD b�bD � '�� ' (�S <br /> LEGA LOT�Q BLOCK TRACT <br /> DESC. `� �OO��" <br /> OYINER ADURESS �r�C�///,p)'� �, CITY2IP PHONE ��s�S J f <br /> 1��•r��.�- �/���J.� �. Gl ,��t; ��f1��� ��.a^ �%� • �`�b�L�'c. �i 'NEf; �J/� �11�3 C�G - `� <br /> „� <br /> TENANT�N MEr CONTACTFOR PERMIT PHONE <br /> CONTRACTOR �� �� I-7.qP � a ADDRESS CITY2IP , PHONE �S 3�— <br /> ll GL �o33a-- (o`I�C� �, j�1J. �111[���lfYp l•O)9 �SZ7� <br /> CONTR.LICENSE p ��� E�.D�e y�� � /!,j 3 .�-��3 ' (�d ' <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> L-�d �-( �/. _Eleclric _Gas_Other <br /> ���_ <br /> WORKDESCRIP710N q�(L 2 �,��(a.�.� �'(' /CZ�Ci G(7iTItJ </!�L'Z�' LUQ�=�-� G(?7 >/J . <br /> �� J <br /> �[?X1 ���! !�'; �IOi )4?i GZ Y'Gl� ��C,Y �t_ C( , - <br /> J u <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> BathWb Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchei �nk&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Cblhes washer Clolhes dryer <br /> Waler heater Range hood <br /> Sink(service/badmop/etc.) _ Exhausl fan <br /> Backllow preventer _ Heal pump <br /> Urinal Unil heater <br /> Drinking Founlain Boiler <br /> � Floor drain _ Refrigeratlon <br /> � Groase lrap _ Woodslove <br /> Roof drains Other <br /> Olher <br /> � CI1Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y that I have read and examined lhis applicalion and Lnow the same to be We and correcL All provislons of laws and <br /> ordinaces goveming this lyp�of work will be complied with whother sp�cifed herein or noL The granling of a pem�it does not prosume <br /> lo give authority to violale or cancel the provision of any olher slale or Iocal iaw regulaling construction or the periormance of <br /> conslruction.Thal I am authonzed by tho owner of this property to perform the work forwhich application is made and I wmply with the <br /> Slate Conlractors Law J8.27 RCW and 296.200 V�AC.`� <br /> ('� �������_ x�� '�i yla�� <br /> Signature o(Ow dConlractodAuthonzed gent ate � <br /> z <br />