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�tRMIT APPLICATIdN <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� .. �/-O � <br /> SITE AD�RESS PARCEL TAX I.D.# PERMI i# <br /> � lCa \ `Z c� � �r�nc-a�-e. l.L�r�i..� m� i f Q -C1oZS <br /> LEGAL LOT NU. BLOCK TRACT OR SUBDIVISIPN# <br /> DESC. <br /> OWNER � ADDRESS CITYIZIP PHONE <br /> �� <br /> t ���5 ��D 1- ll� l <br /> '�i)C .' �L �'�.tL ['•�c'l r i l Cc �-� � C< <�i_ /��(�(t� L V� C. (1�1 1 5 .JO�''� <br /> TENAN NAME CONTAC FOR PERMIT PIiONE <br /> I ���'�C,�C ��\(Ll`C `�'> > -�`�.� �5�� ) <br /> E-MAIL <br /> CUNTRACTOR ADDRE ` ITYI P PHON° <br /> ��..11�Cl_''�Cil �,C.O��Il� l��'�C� t l�� �C�1 C�[i'l �n�.l �� �d S <br /> CONTR.LICENSE# � � ^ � f\ ����'� �U � �fi �� � L-�eS a -��L� <br /> 11 �tf'T�� 'f-� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric l�Gas_Other �,`-l � ��(1 •�L'� <br /> WORK DESCRIPTION <br /> �����\\ C'���=-� ��c�«C.c�, L� , a. v, «�c�C�� C��i( <br /> � <br /> PLUMBING MECHANICAL <br /> NO. 'fYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> . Balhtub oG Forced air syslems <br /> Lavalory (wash basin) Gas pipinc� <br /> Shower Waler healer <br /> Kilchen sink&disposal Gas tireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mopletc.) Exhaust(an <br /> Back(low prevenler Heal pump � <br /> Urinal Unil healcr <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodslove <br /> Roo(drains Other <br /> Olher <br /> CiTY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby c�ritify that I have read and examined this applicalion and know the same lo be true and correcL All provisions of laws and <br /> ordinaces governing lhis type of work will be complied wilh wheUier sNecified herein or not.The granling of a permil dcas not presume <br /> to c�ive authorily to violate or cancel Ihe nrovision of any olher stale or local law rec�ulat��g construclion or lhe pedormance o( , <br /> conslruclion.That I am authorized by lhe owner of this property to perform the�vork for v:hich aonlicalion is made and I comply with lhe <br /> Slate Conlraclors Law 16.27 RCW and 2�J6.2 WAC. <br /> ` � ( �� - / r-c� <br /> . �,� i <br /> SignaWr vnedGont�o�nzed Agent Date <br /> �.__� � <br /> ` - -- —I <br />