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4 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRFET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-?.57-8857 —�w✓w.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � -Z —/�_p� I <br /> SITE ADDRESS S G`�� �O� P.4RCEL TAX I.D.# P RMIT <br /> r�..�.�u,� �`�a - o; �, <br /> LEGAL LOT NO. BLOCK TRACT OR SU6DIVISION# <br /> �ESC. <br /> OWNER ADDRESS CIN/ZIP PHONE u 7r�/�� <br /> G�2 o�-'�cQ.�Cp . lDlO .S� . �i��� ���� z�J <br /> �—�_ � <br /> TENANT NAME CONTACT FOR PERMIT PHONE �.3)7(}�/�7 <br /> ..,�f c ( <br /> /g'�LQT�� �EG/ tl" �/T�l�-d�L E-MAIL <br /> CONT CTOR AD ESS CITYIZIP PH_ Of{���` <br /> �r,�c�c,yt,�Q�(R ntcCa�' CC�"�c »t�� � n!!.U'��� � ��,�s 7 [�7 <br /> CONTR.LICENSE# <br /> -��-ctJ�Rn� 1�2Z�'�H L8 t�-- �Z ��� <br /> USE OF Bl11LDING HEAT SOURCE CONTRA�PRICE OF WORK <br /> �Jf � ��_ <br /> ��� �p _ElecUic _Gas__Olher <br /> (Yf�'� <br /> WORf(DESCRIPTION <br /> PLUMBING McCHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FiXTURE OR ITEM <br /> Toile; A/C-air handlir.g units <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> � Kilchen sink&disposal _ Gas(ireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> � Water healer _ Range hood <br /> Sink(service/bar/moplelc.) _ Exhaust(an <br /> Backflow Urevenler _ Heal pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ 'Noodslove <br /> Rnof drains Olher_ <br /> i _ Other __ — . <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerilify lhat I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing lhis type of work will be complicd wilh whether specified herein or noL The granting o(a permi!does nol presume <br /> to give authority to violale or cancel lhe provision of any other stale or local law regulaling consUuction or the performance o( <br /> li conslruclion.Thal I am aulhorized by the owner of this property lo perform the work for which applicalion is made and I comply with Ihe <br /> I State C ntractors Law 18 RCW and 296.200 WAC. <br /> � i T—/,S'O� � <br /> Signature of OwneNConUactor/Authorized Agenl Date �/ ���.� <br /> J <br />