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PtRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, VJA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS 2 E6 n� 5. r PARCEL TAX I.D.# PERMIT p <br /> � - y3 X�,�� -m, <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> Fu110 Y�L- Ta�„'r� 2 �fY-25o Fl.tis,- iiu�or) �.baoSz� S �4��> ZG� 1�14I <br /> TENANT NAME , I CONTACT FOR PERMIT PHOP(E <br /> i <br /> �: �li� � � L ,�r�y,-�; ��� n�-�,� ,��- <br /> CONTRACTOR ADORESS CITYIZIP PHONE <br /> CONTR.LICENSE p r , ,�v\�� i,� <br /> � <br /> USE OF BUILDING I HEAT SOURCE ( CONTRACT PRICE OF WORK <br /> �/Electric Gas_Olher <br /> WORK DESCRIPTION <br /> ;1 � � 5.�� w�-�, � o�-�� <br /> � <br /> PLUMBING MECHANICA!_ <br /> NO. TYPE OF FIXTURE OR ITEM NO, TYFE OF FIXTURE OR ITEM <br /> Toilel A/C—air handlin��unils <br /> BalhWb Forced air syste�ns <br /> lavaloiy(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> = Clothes washer � Clolhes dryer <br /> Waler heater Ranc�e hood <br /> Sink(service/bar/mop/etc.) _ Exhausl fan <br /> Backflow prevenler Heal pump <br /> Urinal Unil healer <br /> Drinking Foun�ain _ Bo�ier <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerilify lhat I have read and examined lhis applicalion and know the same lo be true and correct. AI�provisions of laws and <br /> ordinaces governing Ihis typo of work will be complied with whelher specified herein or nol.The granling of a permil does not presume <br /> to c�ive aulhoriry to violat?or cancei lhe provision of any other slale or local law reguiating construction or the performance ot <br /> conslruction.Tha��l am aulhorized by lhe owner of this property lo perform lhe work for w•hich applicalion is made and I comply wilh the <br /> Slale Conlraclors Law 18.27 RCW and 296.20U WAC. <br /> !�/� / a � <br /> �`�% G' /'"/ <br /> Sic�nalure o('OwnedConlractodAuthonzed Agenl Date <br />