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PEKIIAIT APPLICATIO�v <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 /> U N j r �� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ;� I 26 PA-i N � r�� �p w P��! �vS3 � ODDd/� c:v Co�ocn- U <br /> LEGAL LOT NO. BLOCK TR T OR SUBDIV N k� �� <br /> oEs�. j a,c .,.e ���;� _ <br /> OWNER AODRESS CITY�ZIP PHONE <br /> � i<b -r-o,�G -rso►� iSioi � Z�N av� u� �y� r��o� w� q8o37 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> W ry" L c E•MAIL <br /> � �, TRA TOR A S C I IP N <br /> C NTRI�I E SEp� �A��r 1���� llC, ��1M1? � �-S l4'Qd��-' ZQ6��U �Y-7Q�.0 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> SG� _Electric _Gas�Olher <br /> / <br /> WORK DESCRIPTION <br /> � �tb�y 1�A� � c �y� <br /> s r Po�- b s'-o�-6 4o X L�{ zo b'-6 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR I7EM <br /> Toilet A/C-air handling unils <br /> 6alhlub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower W ater healer <br /> Kitchen sink 8 disposal _ Gas(ireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Waler heater Ranc�e hood <br /> Sink(service/badmop/elc.) _ Exhaust fan <br /> BacY,Oow preventer _ Heal pump <br /> Urinal Unil heatcr <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease Irap Woodslove <br /> Roo(dreins Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceritify Ihal I have read and examined lhis application and know the same to be true and correcl. A�I provisions o(laws and <br /> ordinaces governing this lype o(work will be complied with whelher speci(ied herein or noL The grenting of a permit does nol presume <br /> to give aulhority to violale or cancel the provision of any olher stale or local la�v regulating construclion or the performance of <br /> conslruction.That I am authorized by the owner of this property lo periorm the work for which app�icalion is made and I compiy with Ihe <br /> Slale Conlractors Law 18.27 RCW and 296.200 WAC. �/ <br /> � l �' �07 <br /> i�--� � �ti= � � <br /> Signalure o(OwnedCo tra torlAulhonzed Agent Date � rZ <br />