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//�itlf77 �te �t <br /> � � � <br /> P�RMIT APPLICATION <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 AM TO 4 PM �D �J/-fJ,b <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT N <br /> ' �f/ Pc�io . <br /> �. <br /> � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITY/ZIP PNONE <br /> l ��t,'��n f p� '/�! � fr S <br /> TENANT NAME CONTACT FOR PERMR PHONE <br /> l�-rr' ��Fl;���� ���5 <br /> CONTRACTOR �F�,�. h1tc.4•t+�� c aL �DRESS CITY2IP PHONE <br /> �, � � P��-� (k.,,,-� y7Z? 3 3�u-737-Gsos <br /> CONTR.LICENSEM �I�IYILLr yS�/LC. l��t/..,,yh.v <br /> USE OF BUILDING I — NEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric Gas_Other ,� 3(�c� ). DU <br /> WORK DESCRIPTION <br /> Qoua�a- «. Tc.� ��,...�1�.,,y <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIX7URE OR ITEM NO. TYPE OP FUC7URE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhtub Forced air�ystems <br /> ,� Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposai Gas fireplaco <br /> Dishwasher Gasrange <br /> Cbthes washer Clolhes dryer <br /> Laundry lny _ Rangehood <br /> � Sink(sorvico/bar/mop/etc.) _ Exhausllan <br /> Backllow prevenler _ Heat pump <br /> Urinal Unit hoater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Groasc Irap Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify Ihat I havo read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveminp this type of work will be complied with whether specified herein ar not.The granting of a pertnil dces not presume <br /> to flive aulhority lo violate or cancal lhe provisian ot any other state or local law regulating construction or the periormance of <br /> construction.Thal I am aulhorized by lho owner of this property lo peAorm the work for which application is made and I comply with the <br /> Slate Conlractors Law 18.27 RCW and 296.200 WAC. <br /> Signature o(OwnedContractor/Authorized Agent Data <br />