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PtRMIT APPLICATIUN <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 8 AM TO 4 PM <br /> S�TE ADDRESS PARCEL TAX I.D.8 PERMIT# <br /> IU10t�:G�j-Cx-{ <br /> LEGAL LOTNO. BLOCK TRACT <br /> DES!.. <br /> OWNER ADDRESS CITYlZIP PHONE <br /> �o� �I,t �-3 3� rc, l/�/-e- �l - 3 - �� <br /> TENANT NAM I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITYlZIP PHONE aS <br /> CONTR.LICENSE p �� G� � 3 vO 7 <br /> ,v�Is�H/e i�l� a 9a � � �� �I�e� 19�.� �z�,�- , �aos� <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric �Gas_Other .�� (�(JQ. Od <br /> WORK DESCR�PTION <br /> _Ltist�.l� �1as l�il°I1,� d-o L'rh�SY�kJ -�i,.rtti� ce lu�<.f-iol, � t✓afiev-- <br /> �J 1 � a S r/'a L.5 -�- <br /> h-en t-e r �a� Q � ��, or <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTIlRE OR ITEM <br /> Toilel A/C—air iiandling unils <br /> � Balhtub r_ Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower � X Waten c�ater <br /> Kitchen sink 8 disposal � � Gas tirepiace <br /> Dishwashcr � _ Gas range <br /> Clothes washer _ Clothes dryer <br /> � Water heater _ Range hood <br /> Sink(service/badmop/etc.) _ Exhaustfan <br /> Back(low preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I here6y ceritify ihat i have read and examined this application and know the same to be We and cortecL All provisiors of laws and <br /> ordinaces goveming this lype of work will be complied with whelher specified herein or nol.The granting of a pertnit does nol presume <br /> to give authonry to violate ur cancel the provision of any other state or local law regulating wnstruclion or the peAormar.ce of <br /> construclion.That I am authorized by the owner of this property to periorm the work tor which application is made and I comply with the <br /> Stale Contraclor L w 1 .27 RCW and 29�200 WAC. <br /> ,� �� �e � � <br /> Signat e o OwnedContractor/Authori�ed Agenl Dale <br />