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PER�JIIT APPLICATION <br /> CITY OF EVERETT F'ERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WF 98201 I <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � � -3 ..OS <br /> SITE ADDRESS PARCEL TAX I.D.# �RMIT# _ _/� <br /> � I 2 y Sc= �vc�-� f(- ��It 'F 'Z��S"1 �'Do v LZ�'� � <br /> LEGAL LOTNO. BLOCK T ACT <br /> D[SC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> Sf��P ��5��- �c��.,�� zo4 �i sti i3 � -�� 9� <br /> TENANT NAME CONTACT FOR PERMIT PN'JNE <br /> S�ec� Lov.�Fry $ �cv� f�Lc��� 4 Y��S`- 776 � �f3S— <br /> CONTRACTOR_� A��RESS � CITYIZIP PHONE <br /> Q�..�,y ..v��,v � o �,�oo M��-(�s� iz..F' �f ro= <br /> CONTR.LICENSE M 71�..���— <br /> �:.-rr•�n/tu %JClv. ��[,rt(—�- !{/�- '�7�20 j <br /> USE OF BUILUING I HEAT SOURCE CONT�2ACT PRICE OF WORK <br /> �G ��` _Electric _Gas_Olher � U.� <br /> � s���� z 9� �s�° <br /> WORK DESCRIPTION . <br /> �.ti:5�? [� (z) S�•�S oF Les� ! ef-�c,�' T <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Eathlub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas freplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Laundry lray _ Range hood <br /> Sink(servicelbar/mop/etc.) Exhausl fan <br /> _ Backfiow preventer _ Heat pump <br /> _ Urinal _ Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drein Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other _ <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify that I have read and examined this application and know the same ro be true and correct. All provisions of laws and <br /> � ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> � �, to give authority to violate or cancel the provision of any other state or local law regulating consUuction or the pedormance of <br /> I construction. That I am auth rized by t owner of ihis property to perform the work for which application is made and I comply with the <br /> � State Contrectors Law 1 RC 296.200 WAC. <br /> � �j�� <br /> �� Signatur . UContractor/Authorized Agent Date <br /> � Z <br />