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PEKMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— rAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> 6r �� Pese�� P�.cec e -7� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ,��N,J�S ,�r�w� l7ny ,Q�cke��,ller #I CVert1T� �f�1dl YzSzs j �s� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR C' ADDRESS CITV2IP PHONE <br /> ,, �e ��� <br /> CONTR.LICENSE# <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �� 1^ �Eleclric _Gas_Olher <br /> / <br /> WORK DESCRIPTION <br /> e2''- OF"f` � Pc� l[aO f� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling unils <br /> Balhtub Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower 1Nater heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Cbthes dryer <br /> Water heater Range hood <br /> Sink(service.'bar/mopletc.) _ Exhaust fan <br /> Backllow preventer _ Heal pump <br /> Urinal Unil healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodslove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> I hereby ceriti(y thal I have read and examined this applicalion and know the same lo be lrue and correct. All provisions of laws and <br /> ordinaces goveming this lype of work will be complied with whether specified herein or noL The granting ot a pertnit does not presume <br /> to give authority lo violale or cancel lhe provision of any other stale or local law regulating construclion or lhe peAormance of <br /> construclion.That I am aulhorized by lhe owner of this property to perform the work for which application is made and I comply wi�'i lhe <br /> State C ntractors Law 18.27 RCW and 296.200 WAC. <br /> ���- �-�tiw� j- �8 �(' <br /> Signalure of Owner/Contractor/Authonzed Agenl Dale <br />