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PERMIT APPLIGATION <br /> CITY OF �VERETT PERMiT SERVICES <br /> 320� CEDAR STREET, EVERETT, WA 98201 <br /> 425-257•8810- FAX 425-257-8857 -www.everettwa.org <br /> �(hj � � � APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.A PERMiT p <br /> i�126 Pk�N � r�c �u wA�Y -�vs3� ODOd/� � co7o� - G <br /> LEGAL LOT NO. BLOCK TR T OR SUBDIV N#� � ^ <br /> oesc. j pc.( tie �Y.i� o� _ <br /> OWNER ADDRESS CITY2IP PHONE <br /> �� I<6 Tbl�G' 'T5o tc i 8t o ► � z��+ a�� W �-y� ��oa� wh qgo 3 7 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> W'T �'"� E-MAIL <br /> NT ACT A SS CI fZl <br /> (.mbblesTon�C cv�Gr r,����Ls �lc �,�wr � �-.r kaa��e 2e, 6-�2G'c�7�� <br /> CONTR. LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> SC� _Flectric _Gas�Olher _ <br /> I <br /> WORK DESCRIPTION � <br /> � �ro�y 1�H� � e, �y <br /> srPA- b�'-o �`6 4axL�{ zo �6 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel WC—air handliny units <br /> 6athtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water healer _ Range hood <br /> Sink(service/bar/mop/elcJ _ Exhausl fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Doiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodslovc <br /> Roof dreins Other <br /> -- Olhcr <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerilify lhat� have read and examined this application and know the same to be troe and correct. All provisions of laws and <br /> ordinaces goveminc this lype of work will be complied with whether specified herein or nol The granting of a permil does nol presume <br /> to give authoriry to violate or cancel Ihe provision o(any other slate or local la�v regulaling construclion or the peAormance of <br /> construction.That I am aulhorizeA by lhe owner of this property to periorm the work tor which application is made and I comply wilh the <br /> Slate Contractors Law 1827 RCW and 296.200 WAC. <br /> i�-� i 61�l a� <br /> Signature o(GwnedCo Ira IodAulhorized Agenl Date <br /> ,(� <br />