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k- cRMIT APPLICATIvN <br /> CITY OF EVERETT PERMiT SERVICE3 <br /> 3200 CEDAR STREET, EVERETT, VdA 98201 <br /> 42�-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> I��I SITE ADDRESS PARCEL TAX I.D.# /P,E�IMJIJT# <br /> LL'"� KcSs„'}'�t .AVC / ' / CiI/-OG� , <br /> LEGAL LOT NO. 9LOCK TRACT OR SUBDIVISION# I <br /> DESC. <br /> OWNER ADDRESS CITV/ZIf� PHONE <br /> --, I /� _ ' _ <br /> ��V� ��� ���`� �2y � ZZ� f�o`..� ,_-��n /� vc Cv��/C�-f. c�� LJ� �`� ';` ;l; ,ii�, <br /> TENANT NAME CONTACT FOR PERMIT PHONE HLS >�S 2��� <br /> ��.ta.c'. !�: 1 '} Ic 1/ E-MAILri.�:.�:�.�.hil.r�(v o �jKrn .�ey <br /> CGNTRACTOR ADDRESS ' � CITY2IP PHONE r <br /> CONTR.LICENSE N r1 <br /> � .� E (- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleciric Gas Other <br /> WORK DESCRIPTION <br /> � <br /> PLUMBING MECHANICAL <br /> �f0. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEh1 <br /> Toiiet AIC-air handlin� unils � <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) I Gas piping <br /> Shower Waler heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> i _ Clothes washer � Clothes dryer I <br /> I = Water heater = Ranye hood <br /> Sink (service/bar/mop/etc.) Exhausl tan <br /> I = Backflow preventer = Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Ooiler <br /> � Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Raot dreins Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hareby cerilify lhat I have read and examined this application and hnow the same W be true and correcl. All p�ovisions of laws and <br /> ordinaces goveming this type of work will 6e complied�a•ith whether specified herein or not.The grantiny of a permil does nol presume <br /> to give authoritq to violate or cancel Ihe provision of any other stale or local law regulating constructien or�he per(ormance of <br /> construclion.Thal I am authorized by lhe owner of�his property lo perform the work tor which epplicalion is made and I comply wilh the <br /> Stalo_ ntraclors Law 18.27 W and 296.200 WAC. <br /> � /l 2 O� <br /> Signature of Owner/ o ac /Au�horized Agent Da <br /> � <br />