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PL�ZMIT APPLICATI�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9f3201 <br /> 425-257-8810— FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE 3 D�ESS�rn�� � PARCEL TAX I.D.# PEjtydlT M �I � <br /> /�%�G <br /> LEGA LOTNO. BLOCK TRACT � <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> X `CIN�t �G�NII IN 1332 �N� � ��/_ W � 1�7(�' <br /> TENANT NAME CONTACT FOI�PERMITI I PF10NE <br /> x �iN�! ��(��K �H �OL, ' GSO • O�I07 <br /> CONTRACTOR � ADDRESS CITY2IP PNONE ZUG ' <br /> CONTR.LICENSE N � � 2 3 Z /' _ N ,A !.L ._ ��f'� ((�� nq07 <br /> OL(]��,Q(" � V'r t� (�1 f 7��� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORKDESCRIPTION ��IS'l'�-LL G�}-5 I 1hlX/6 �- �`I�n/ I��IC� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIX7URE OR ITEM <br /> Toiiet A/C—alr handling units <br /> _ Bathtub Forcedairsystems <br /> Lavatory(wash basin) � Gas piping <br /> Shower Water heater <br /> _ Kitchen sink&disposal Gas fireplace <br /> Dishwasher � Gas range <br /> Clothes washer Ciothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Enhaust fan <br /> Backtlow preventer Heat pump <br /> ^ Urinai Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refigeration <br /> Grease trap Woodstove <br /> Roof drains � Other <br /> Other <br /> I <br /> I CITY OF EVERETT LOCAL SALES SAX CODE IS 7103 <br /> i <br /> iI hereby ceritify that 1 have read and examined this applicatlon and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this rype of work will be complied with whether specified herein or not.The grantlng of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construcUon or the performance of <br /> '� construction.That I am authorized by the owner of this property to pertorm the work�or which applicatlon is made and I comply with the <br /> i State Contractors Law 18.27 RCW and 296200.WAC. <br /> � '� � ���� <br /> i ,X �-�l�%� ��u�;��— � �N zvoy <br /> ' � SigpatGre o�enContractorrAuthonied Agent ate � <br /> �� <br />