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1 <br /> PtRMIT APPLICATICIN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-3857—www.everettwa.org <br /> J ;-=� APPLICATIONS ARE ACCEP"i ED FROM 8 AM TO 4 PM <br /> � <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT Ih O/� <br /> i� ia� �� �.�0�� � oa <br /> LEGA LOT NO. BLOCK GT OR SUBDIVISION# <br /> DESC. <br /> OWNER / A�DRESS CITY/ZIP PHONE <br /> ,� `o r5 vi k <br /> TENAN NAME CON��ERMIT PH AtjE;? <br /> I (�/C.� zz4� ' ��� � <br /> TRAC R ADDRESS � F � <br /> CONTR.LICF ISE# / n L4/y✓J � " ' —� ��(�� <br /> l�✓;.J v <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK — <br /> Eledric _Gas_Other <br /> WORK DESCRIPTION . <br /> � Gt-��C.� 3 O y � (✓/C�ti /��c1 <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FiXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toil�� A/C—air han.11inc�units <br /> � 6athtub �l Forced air sy:;lems <br /> `j Lavalory(wash basin) ��� Gas piping <br /> Shower Watcr h�a;�r <br /> � Ki�chen sink&disposal ]_ Gas lireplace <br /> � Dishwasher Gasrange <br /> � Clothes washer � qothes dryer <br /> Water heater Range hood <br />, Sink (servicelbar/mop/etc.) � Ezhaust(an /�// <br /> Backllow preventer _ Heal pump <br /> Urinal _ Unit hcaler <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigerelion <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF[VERETT IOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this applicalion and know the same lo be lrue and wrrect. All provisions oi laws and <br /> ordinaces governing this type o(work�vill be complied with whelher specitied herein or noL The granting of a permit does nol presume <br /> lo giv�authorily lo violate or cancel Ihe provision of any olher state or local law regulati�g wnstruction or lhe pertormance of <br /> construction.Thal I am authorized by lhe owner ol Ihis property lo periorm the work tor which application is mede and I comply with the <br /> Slale CoNractors Law 18.27 RCW and 296.20D WAC. <br /> 1f�1�� � <br /> Signalure o(OwnedContraclor/Authorized Agenl Date � <br /> t <br /> Z <br />