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�-ERMIT APPLICATIt�N <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 /> APPLICATIONS ARE ACCEPTED FROM 6 MA TO 4 PM �O�j/ —OG <br /> SITE ADDRESS PARCEL TAIC I.D.R g�RMIT R �� <br /> / / - /oC 0 / OD l� ti /o - -3 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��Efi /���s�;,�L ,tt,�;�- ,. 3/a� �16� av � 4a� Ya�s-.����Z� <br /> TENANT NAME ONTACT FOR PERMIT r'r— PNONE <br /> Sc�h�.� I S'tP.�,c Ke�� Y�s= 5'og 6 ri� <br /> �C N CT9R ADDRESS CIiY21P PNONE <br /> uC�r�flh>v5,ltg- /EufZ..o��4s� 3ro' t.o/��. �uc 9'flao( <br /> CONTR.UCENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric �Gas_Other 9 d � <br /> WORK DESCRIPTION [ V pl�S��•�t�- FQ �'7 C- /,fa.H�0.y � '� V �K �'Q sin.►n4 <br /> PLUMBING r �HANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE l F FIXIURE OR ITEM <br /> Toilet A/C—air handling unib <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kilchen sink&disposal Gas fireplaco <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mopletc.) _ Exhaustfan <br /> BackFlow preventer _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boller <br /> Floor drain Refrigeralion <br /> Grease trap WoodsWve <br /> Roof dreins � Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined ihis application and know the same to be We and correct. All provisions of laws and <br /> ordinaces yoveming this lype of work will be complied with whelher specified herein or not,The granting of a pertnit daes nol presume <br /> to give aulhorily to violate or cancel the provision of any other state or local law regulating constructlon or lhe perfortnance of <br /> construction.That I am authorized by the owner of this property to peAortn the work for which applicatlon is made and I comply with the <br /> Slate onlraclors Law 18.27 RCW and 29�.200 WAC. <br /> ��>�., ��t� � l�� /fs o 6 <br /> Signaturc� wn�n rac odAuypbnzed Agent e� <br /> �n <br />