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C <br /> Pt�RMIT 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 /> � -io -o7 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.i1 P MIT# , �� <br /> /i/ sE E✓ErcL=7T fv19�L Wfl � D� �/S <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> E-MAIL <br /> ONTRA OR ��� �L��, ADDRE S 40 � � <br /> /D7zo�7s[= 2r/` S7� KcN* �ol� -3��-`/ Y� <br /> CONTR.LICENSE# � / CI S�3 / <br /> d- �- vb <br /> USE OF BUILDING ( — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> .^ <br /> ��—rje�=� Eleclric Gas Olher � Z� L <br /> WORK DESCRIPTION <br /> /�.J 5'ri4t-L `1Zc�0 k � TG��-r=� St tiJ K .$' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> ^ Bathlun Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> 2 Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clethes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust tan <br /> BackOow prevenler _ Heat pump <br /> Urinal Uriil heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Rofrigeration <br /> Grease trap _ Woodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVtRETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify thal I have read and examined lhis appl,calion 2nd know the same to be true and correcl. All p;ovisions o(laws and <br /> ordinaces c�oveminc�this lype of work will be complied�vith whether specified herein or nol.The granting of a permit does not presume <br /> to givo aulhority lo violate or cancel ihe provision of any other slate or local law regulaling construction or lhe performance of <br /> conslruction. ihal I am aulhorized by lhe owner of this pruperty lo pedorm lhe work for which applicalion is made and I comply wilh lhe <br /> Slal Conlractors Law 18.27 RCW and 296.200 WAC. <br /> . 'h � _ '0 -�9 <br /> Sic�nel re o Own6dConlrac r/Aulhorized Ac�enl Date <br /> ( <br />