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i <br /> PERMIT APPLICATION <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 6 AM TO 4 ?M <br /> SITE ADDRESS PARCEL TAX I.D.# ERMIT� <br /> �G-C�- ��-er.� f�_ �as�as �� o� i� � 7 - <br /> LEGA LOTNO. BLOCK TRACT <br /> DES0. � Z. <br /> OWNER ADDRE55 CITY2IP PHONE y L f--. 3f$ <br /> L�f�"J24z Lvr2r�,X L �� '� 3/�oi �tc�e� rfi.�-�. ��2-0, �sut <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> S!!!v�-�_ I 5lltitL� ��J- 2/0 -3'1���' <br /> CONTRACTOR ADORESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDINj HEAT SOURCE CONTRACT PRICE OF WORK <br /> � ��C'e C��� � L _Electrit �as_Olhor <br /> WORK DESCRIPTION � <br /> � PC�Y CICat'"1� �L7�rrt r� � �GC� ��^ �"� �l' ��°�"J I�� � <br /> 0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling units <br /> Balhlub Forced air systems <br /> Lavatory(wasli basin) _ Gas pip(ng <br /> Shower Waler heator <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Walcr heater Rango hood <br /> _ Sink(service/badmop/elc.) __ Exhaust fan <br /> BackOow preventer Heal pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floordrain i Refrigeration <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVEFETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify ihat I have read and examined this application and know the same to be true and correct. All provisions cF la�+s and <br /> ordinaces governing lhis lypo ot work will bo coinplied with wholher specified herein or not.The granting of a pertnil does not presumo <br /> to give authoriry to violato or cancel tho provision of any other state or local taw regulaling construcdon or the performance of <br /> conslruction.That I am aulhorized by t owner of this property to pertorm the work(or which application is made and I comply with the <br /> State Confractors Law 16.2 W a d 296.200 WAC. <br /> ���(CJ=-`i�. C� <br /> Signature of Owner/ContractuilAuthoriz tl Agent Date <br />