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PtRMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S --7-�O� <br /> SITE ADDRESS PARCEL TAX I.D.� �� <br /> 2-0� S e �;}� � -II - ob35 05-��3 <br /> LEGA LOT NO. BLOCK TRIICT OR SUBDMaION t <br /> DESC. <br /> OWNER ADD E CITY IP / <br /> QCe�-,✓ (�Ae��'c I�(�J- LL. C • �)� S'S4 � �7 hC0 <br /> TENANT NAME CONTACT FOR PERMIT �� <br /> �C.'�NNr- W�Gf I ZS1 S �1 Y.aG���i11tJ E�AAII <br /> CONTR.LICENSE il <br /> U�S�O�F BU1 ILDING S�F n�� I 1 ElectriEAT SGas CE Other I CONTRACT PRICE OF WORK <br /> � C�l <br /> WORKOESCRIPTION � «,t�,4,ef <br /> Z�Ns��i 3�on-a..ww.,r{. Sr�+K . qNL c��c.-51 T�••P / g/1GK�o I°r <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIX7URE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> Toilet _ A!C-air handling units <br /> Bathtub _ Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink 8 disposal _ Gas flreplace <br /> Dishwasher _ Gas range <br /> Cbthes washer _ Cbthes dryer <br /> Water heater Range hood <br /> � Sink(service/barlmopletc.) � E�aust fa� <br /> BackFlow prevenler Heat pump <br /> Urinal _ Unit healer <br /> Orinking Fountain Boiler <br /> Floor drain _ Refigerallon <br /> � Grease trap _, Woodslave <br /> Roof dralns — �ef <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAl(CODE IS J705 �� <br /> I hereby ceritify that I have read and ozamined this applicatlon and know the same lo be tn�e end comecl. PJI proWsbns of lawe and <br /> ordinaces goveming his type of work will be complied with whether specified hereln or�ot The pranUng of a peimN doas rwl presume <br /> to give authority to violate or cancel the provision of any olher state or local law regulatlng consWctlon or lhe performance of <br /> construction.That I am auttrorized by the owner of this properry to perform the work(or which applkstbn is made and I compy wilh the <br /> State Contraclors Law 18.27 RCW and 296.200 WAC. <br /> '";il �r---� S''�l -�9 <br /> Sign ure oi OwnedContrectorlAuthorized Agenl Date I <br /> i <br /> ; <br />