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PE�MIT 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 8 AM TO 4 PM <br /> SI1'E ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �� �a�,� �E �3° �7 mv ��2,-oy� <br /> LFGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> . , � �� Cs�y)773-s�17� C'�f <br /> l.l)a l� VeResc`G 4' �,� 2�(.�e l�aavad f�ve 3o.Z �ve�en77, ,1�� <r,rs��s7v-�>�r� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS C11Y21P PHONE <br /> CONTR.LICENSE fi <br /> USE OF BUILQING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF tIXTL'RE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air har�iling unils <br /> Bathtub Forced air sy:'oms <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower W ater heater <br /> Kitchen sink&disposal Gas(ireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> Water heater Ranc�e hood <br /> Sink(service/bar/mop/elc.) _ Exhausl ian <br /> Backflow preventer _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigerelion <br /> Grease lrap _ Woodstove <br /> Roo(drains Uther <br /> Other <br /> CITY OF EVERET7 LOCAL SALES TAX CODG IS 3105 <br /> I hereby ceriti(y thal I have read and examined Ihis application and knnw Ihe same lo be lrue and correcL All provisions o(laws and <br /> ordinaces goveming this type o(work will be complied with whether specified herein or not.Tho granting of a permit does not presume <br /> to give aulhonty to violale or cancel lhe provision o(3ny other stale or local law regulaling consiruction or the performance of <br /> construclion.That I am authorized Ly the owner of this property to pedorm the work for which applicalion is made and i comply wilh lhe <br /> State�onlractor�Law 182 CW and 296.200 WAC. <br /> ���' - lt��cd ��c.�� /���'T��6 <br /> ignature of Owner/Conlractot! uthonzed Agent Date <br /> �/ <br />