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PE�.MIT APPLICATIOI� <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 /> /�� l APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �Z��S�O.G <br /> SITE ADDRESS PARCEL TAX I.D.A PERMIT t <br /> rr K v 3 - e -!- mo -o <br /> LEGA lOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �,FPF7r/�av$�vt�A !}uf�to/i'f� �/d�Ga/�i aivc gde�o/ �1e�-5=3�3//oz/ <br /> TENANTNAME CONTACTFORPE MIT PHONE <br /> �ri.l�� < <Sf�r�-c_ Ha-5=�iff-6�17 <br /> ONTRACTOR ADDRESS CITY2IP PHONE <br /> �r',�E���s„�y. M�r��� 3�0 �����. a�� 9Bao r ���s a-bs�z <br /> CONTR.LICENSE R <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S _Electric �Gas_Olher � <br /> WORKDESCRIPTION ������u�t�.t� �,�'js��pr lQtS�OCstCG <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OP FIXTURE OR ITEM <br /> Toilel AIC—air handling units <br /> Bathlub Forced air syslems <br /> _ Lavalory(wash basi�) /� Gas piping <br /> Shower ��,� Waterhealer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer I � Clothes dryer <br /> _ Waler hoaler � i,_ Range hood <br /> Sink(servicelbar/moplelc.) �,B_ Exhaustfan <br /> Backtlow prevenler _ Heat pump <br /> Urinai Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Retrigeralian <br /> �reasetrap _ Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I here6y ceritify thal I have read and examined lhis applicalion and know the same lo be lrue and cortect. All provislons of laws and <br /> ordinaces governing tliis lype of work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> to give aulhority lo violate or cancel the provislon oi any other slale or local law regulaling construcQon or the peAortnance of <br /> construclion.That 1 am aulhorized by the owner of this property to peAortn the work for which application is made and I comply with the <br /> Sta Contraclors Law .27 RCW and 296.200 WAC. <br /> a- �� ,O�C• <br /> ignaWre of Owner o clor/Aulhonzed Agenl Date <br />