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PERMIT APPLICATION <br /> CITY OF �VERETT PERMITi SERVICES <br /> 3200 CEDAR STREET, E\'ERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org !�, <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � `O"� `�V` <br /> SITE ADDV?LSS PARCEL TAX I.D.# I P RMIT# � <br /> ► �o-► r Av� 00434��3 r tio 000� 0.,�03� <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION k <br /> DESC. �p� '�J��r (_ <br /> OWNER ADDRESS CITY,ZIP2D PHONE <br /> �L�frJN ADrt.r�S 6�oa7 �foyT o��fC ��-�iT 4z.�2g0 — ,6c7 <br /> TENANT NAME I CONTACT FOR PEiiM1T PHONE <br /> E-MlilL <br /> CONTRA�T�(�i�'1 G �tJIJF�1"Fr A�j 0 l3 �ACI�W �cr CIIY21��Lc P"5Z3•320'47G� <br /> ��� I P' rl <br /> CONTR.LICENSE It �$4Z1}� <br /> TfzIST� 951Q(� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���QQ.1 .�"i _Electric �CGas_Olher � ��,� S�j� �Z <br /> WORK DESCRIPTION -!� TA"X <br /> RE��k��E RO�� S��t� �,t�5 <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FlXTUPE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> Toilet _ NC-airh�ntllingunits <br /> Bathlub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Waterheater <br /> Kilchen sink&disposal _ Gas lireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Water hea�er _ Range hood <br /> Sink(service/ber/mop/etc.) _ Exhaust fan <br /> Backllow prevenler __ Heal pump <br /> Urinal _ Uni�heater <br /> _ Drinking Fountain _ Boiler <br /> Floor drein _ Refrigeration <br /> Greasetrap _ Woodstove <br /> Roof drains _ Other <br /> O:her — <br /> CITV OF EVERETT LOCAL SALES TA:CODE IS 3105 <br /> I hereby ceritify�hat I have read and examinetl�his application and know the same to be�me and correct. All provisions ol laws and <br /> ordinaces goveming Ihis type ol work will be complied with whelher specified herein or neL The granling of a permit does not presume <br /> lo give authority to violate or cancel the provision of any other state ur local law regulating corctmc�ion or Ihe pedormance of <br /> construction.Thal I am authorized by tha owner ol this property to pedorm ihe work lor which appiication is made and I comply with the <br /> State Contractors Law 1827 RCW and 296200 WAC./) <br /> / - ��-r.31--�—�—y( VO �¢� ���/� <br /> SignaWre of �nedCon(iaclor/ uthonzetl Agent C„to � <br />