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NERMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9A201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS , PARCEL TAl(I.D.# P�2MIT�# � <br /> 5`7�'7 -e. �«:..u,2 �t�G Go � v lI �"� �' ��o' - :':_ <br /> LEGA LOTNO. BLOCK TRACT I/ <br /> oesc. �U ' �ui`/N'�vn�' /Tz ' ���I y25- 3ly-.SZ60 <br /> OWNER ADDRESS CITYIZIP PHONE <br /> (/ U rv�2.� � T IfC�� 7'C. �GG`Jicr,-) �U� /✓-C.ICt wu..c �-!/E `/�� / ��v� <br /> TENANTNAME � CONTACTFORPERMIT PHONE <br /> �j,�,,,., G���,�u„ ��� �/�s- 3/9:f°6� <br /> CONTRACTOR AODRESS CITY2IP PHONE <br /> CONTR.LICENSE p �'��� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��'/� <br /> �'U �����4� tlectric _Gas_Olher <br /> o d <br /> WORK DESCRIPT�ON <br /> � '.t - '�' '� -� ^ <br /> , � _ c <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel AIC-air handling units <br /> Bathlub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal _ Gas flreplace <br /> Dishwasher Gas range <br /> Clothes washer C�olhes dryer <br /> Waler healer Ranc�e hood <br /> Sink(service/bar/mop/elc.) _ Exhausl fan <br /> BackOow preventer _ Heal pump <br /> Urinal Unil healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstov j✓j�T <br /> Roof drains _ Olher <br /> � ^ <br /> ' 011ier �u����J <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby cerili(y that I have read and examined this application and know the same to be true and correcl. All provisions of laws and <br /> ordinaces c�overning lhis lype of work will be complied wilh whether specified herein or noL The granting of a permit does not presume <br /> to give authority to violale or cancel lhe provision of any other stale or local law regulating construction or the performance of <br /> conslruction.Thal I am authorized by the owner of lhis property lo perform lhe work for which app�ication is made and I compiy wilh the <br /> Slate Confrj tors Law 1�.2�7 RC1� and 296.200 WAC. <br /> L���- 3 -�8"-a� <br /> Sign t of Owner/Contraclor/Aulhorized Agent Date �/Z <br /> / <br />