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PEkM�T APPLICAT'!O�! <br /> CITY OF EO/ERETT PERMIT SERVICES <br /> 3200 CEGAR STREET, EVERETT, WA 98201 <br /> 425-257-8810– FAX 425-257-8857–www.everettwa.org <br /> APPLICAT�.>NS ARE ACCEPTED FROM 8 AM TO 4 PM �j -�-0�/ <br /> SITE ADDRESS PARCEL TAX I.D.# PE 17# � <br /> '()�- C�' (j '���/� � ��' i � � ��� <br /> IEGAL LOT NO. BLOCK TRAC7 <br /> �ESC. <br /> OWNER ADDRESS CINIZIP PHONE I <br /> /-�(I n !r'j��� /�J ;;� ">� !�n/�`/j),- rul �:!i'/�i _ _ �,-`,-;,"i;.!�I <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �p � <br /> CONTRACTOR U' �J • c�Y � y ADbP.ESS CITY2IP PHONE`::��_� �`-.-_,;��_ �� <br /> lC2�9G�.�,/- <br /> coHra.uceNse u jC'��c'�U %�t' l�y��N� �l/ � <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PRICE OF WORK <br /> _Eleclric _Gas_Olher <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> Bathlub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Waler healer <br /> Kitchen sink&disposal _ Gas fireplace � <br /> Dishwasher Gas range <br /> Clolhes washer Gothes dryer <br /> Water heater Range hood <br /> Sink(service/badmop/elc.) _ Exhaust fan <br /> Back(low prevenler _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease lrap — - <br /> WoodstoVe Jt^ /.;..- r�/�c:GJ <br /> Roo(drains Olher �;. v� ' -' /' � <br /> — — `c°� u� i.l�� �� F�= <br /> olher "' <br /> CIN OF EVERETT LOCAL SALES TAX CO�JE IS 3105 <br /> I heraby cedtify that I have read and examined this application and kno�:lhe same to be true and correcL All provisions of laws and <br /> orAinaces governiog lhis type of woih will be complied wilh whelher speci(ied herein or noL The granting of a permil does not presume <br /> to give authority lo violafe or canccl the provision of any other state or local law regulating constniction or the pedormance of <br /> corstruction.That I am aulhorized by the owner of this properly to perform the work tor which applicalion is made and I comply with the <br /> Slata Conlrac�ors Law 18.27 RCW 2nd 296.2C0 W, . <br /> � /�, � �� �f:� � ��/���i;(�� <br /> K }-'' ,,.: <br /> Signatcre of OwnedQ"ontracror/Authonzed Agent Date <br /> C/ – \'2 <br /> �. <br /> 4 <br /> ;�,a. <br />