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' ' PC:RMIT APPLICATIC�.� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 U 7�2_ 7� <br /> q25-257-8810—FAX 425-257-8857—www.everettwa.org J G <br /> �!/ f APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �- <br /> SITE ADDRESS �f h� Pa.� PARCEL TAX I.D.N P M�N� r � <br /> _ / <br /> LEG LOTNO. � BLOCK TRACT <br /> DESC. <br /> �ER � DDRES CITYlZ1P PHONE � .�� <br /> �,.+� �'� ��vE�ioz l�Sr�tr 9��' <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � BrP.tf"�e_La..1/ h� �zS�-75� - �` <br /> CONTRIICTOR �ma-yt,r� DDRESS ��n'mP y�N�� ,��7O <br /> CONTR.LICEN�4E LAIT�NL�T�+"� "�� J �/V�I�T ��p�/� �/¢ <br /> � <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eledric ✓Ges Other <br /> WORK D SC� RIPTI�N � <br /> �L.L'6LJLei ) b" l <br /> �J ✓ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXNRE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet AIC—aIr handling units <br /> � Bethtub Forced eir syslems <br /> Levatory(wash basin) � Gas pping <br /> � Shower L, Water heater <br /> � Kitchen sink&disposal L Gas fireplace <br /> � Dishwasher � Gas renge <br /> Clothes wasS�er 1 Clothes dryer <br /> _ Laundry tray �L Renge hood <br /> Sink(service/bar/mopletc.) Exheust tan <br /> Beckflow prevenler Heet pump <br /> V Urinel Unit heeler <br /> _ Drinking Fountain �_ Boller <br /> Floor drain _ Rehigeration <br /> — Woodstove <br /> _ Grease trep — a�� <br /> Roof drains — <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE 18 J106 <br /> I hereby ceritify that I have read and examined this epplication and knaw the seme to be true end cortect. All provisions of laws end <br /> ordinaces goveming this typa of work witl be complied wilh whether specified herein or nol.The grenting ot a pertnft does not presume <br /> to give euthority lo violate ar cancel the provisfon ol eny olher stete or local law reguletlng construction o�the performenae ot <br /> construction.Thet I em euthorized by the owner of this property to peAortn the work for which epplicafion is mede end I comply wHh the <br /> Stete Contractors Lew 18.27 RCW end 296.200 WAC. � <br /> ,%�r j <br /> ,� -; <br /> Signature o wnerl ontradodAuthonzed Agent ate �� <br /> � <br /> , '� <br /> I <br />