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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.ory <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7- '�� /�f <br /> SITE ADDRESS PARCEL TAX I.D.tl PERMIT# <br /> e?/3/ G�•o•v� �1vE 1 ou� -csZ,� <br /> LEGA LOT NO. BLOCK TRACT OR SUBOIVISION N <br /> DESC. <br /> OWNER ADDRE55 CITYIZIP PHONE <br /> O�y �i/�.�,f� Z(�I �OLBY E✓G/�� Wil� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE .�/����/'2$9 <br /> %�� 5�6�� E-MAIL <br /> -�sa D � <br /> SELf <br /> CONTR.LICENSE# <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �r���L /��� M� _Electric _Gas_Other <br /> WORK DESCRIPTION W �T// SG'�ssE <br /> ���iv�' EX/f�tin� Go�s'v 12.eoF .+� .�rpLr►cai <br /> PLUMBING NIECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C-air handling units <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas renge <br /> Clothes washer _ Clothes dryer <br /> Waler healer _ Range hood <br /> Sink (service/badmop/elcJ __ Fxhaust fan <br /> 13ackflow prevenier __ Heat pump <br /> Urinal __ Unit heater <br /> _ Drinking Pouniain Boiler <br /> Floor drain _ Refrigeralion <br /> Grease Irap _ Woodstove <br /> Roof drains _ Other <br /> Other — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby certify that I have read and examined this application and know ihe same to be true and correct. All provisions of Iaws and <br /> ordinances governing this type of work will be complied with whelher specified herein or not.The granting oi a permit does not presume <br /> lo give authority!o violate or cancel lhe provision of any other state or loral law regulating construclion or the performance of <br /> conslruction.Thal I am authorized by the owner of this propeAy lo pertorm the work tor which application is made and I wmply with the <br /> Slate Contraclors Law 1827 RCW and 29�200 WAC. <br /> /% � �iL 7�Q/O <br /> Signa�ure of OwnedCoNraclor/Af$honzed Agent Date <br />