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r. <br /> hcMIT APPLICATIOh <br /> CI 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 9 AM TO 4 PM X (D �� ' OD� <br /> SITE AODRESS PARCEL TAX I.D.N <br /> p u,f{" � � O l QD <br /> LEGA LOTNO. BLOCK 7RACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> Sol-�-ercG � Ic c. L�c -_ <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> TI�e r►'Lq,e.s�c. Cc�f� I 1�e.��1. $�cll� w:S-'15'{�4� <br /> coHnencro ����� � QDR�� 3�1� crtrr� PNONE `4� <br /> � P• E�e.re.-tr qa,5'- h'i3- <br /> CONTR.LICENSE• <br /> Qur.t-xM� as� a�F' <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��.e _EleCtriC ✓ Gas_Olher �r�U <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIX7URE OR REM <br /> � ✓ Toilet _ AIC—air handling units <br /> Bathtub Forced air systems <br /> � Lavalory(wash basin) ��� Gas piping . <br /> _ Shower ( ,� Waterheater�ns'�+�'f <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heator Range hood <br /> Sink(service/6ar/moplelc.) Exhaust fan <br /> Backflow prevenler Hoat pump <br /> Urinal � Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Root drains I � � Other,��QtsrwR I�tw�U' <br /> _ Other��;�u✓L _ _ <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby ceriCfy thal I have read and examined this applicaUon and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type ot work will be complied with whelher specified herein or not.The granting of a pertn(t does not presume <br /> lo give aulhorily to violale or cancel the provislon o(any other state or local law regulating constnrcdon or Ihe perfortnance of <br /> construction.That 1 am authorized by the owner ot this property to peAortn the wo-�c for which application is made and I comply with fhe <br /> State CoNractors Law 18.27 RCW and 296.200 WAC. <br /> �.s.—l-:�l � II-3-G�'o <br /> SignaWre of Owner/ ontractor/Authorized Agent Dale <br /> I <br />