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1 <br /> PtRMIT APPLICATIOrN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.A� PERMIT p <br /> 2.3 � i-�� �c- st� .�rs8 so z cb �sno �Z�� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION i{ <br /> DESC. q — /� �O Z ��i (.. (.�►� b Co . � '�° �-�D ' <br /> OWNER ' ADDRESS CITYIZIP PHONE <br /> � � � K��1� z 3����C s'�- �u��77" 1�.� 982o I y�s-zg3- 033 <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> EaWAII <br /> TR C SS <br /> CONTR.LICENSE# vCC�C:/ �/ <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> /_/� �5��C � � Eleclric _Gas_Other <br /> I �z- <br /> WORK DESCRIPTION <br /> PLUMBING ' MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilcl _ A/C-air handling units <br /> Bathlub Forced air systems <br /> Lavalory(wash basin) �, Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher �_ Gas range <br /> Clothes washer _ Clothes dryer <br /> Waler healer Range hood <br /> SinA(service/badmop/etc.) _ Exhausl ian <br /> Backtlow prevenler _ Heat pump <br /> Urinai Unit healer <br /> Drinking Fountain _ I3oiler <br /> Floordrain _ Refrigeralion <br /> Greaso trap _ �`loodslove <br /> Roof drains Other <br /> � Olher -�(�� � — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y that I have read and'examined Ihis applicalion and know the same lo be true and corcect All provisions ot laws and <br /> ordinaces governing lhis type o(work will�o compliod wilh whelher specified herein or nol.The granling o(a pertnil does nol presume <br /> to give aulhoriry lo violale or cancel the provision of any other state or local law regulating construclion or the parformance of <br /> construclion.Tt��t I am authorized by the owner of this property lo pe�iorm lhe work lor which applicalion is mado and I comply wilh lhe <br /> Slale Contr�7 tlo�s Law 18.2A RCW afd 296.200 WAC. <br /> �'l�fl�� ----� • �ci��,�'�' /Z- 2-�-D`� <br /> Si�nalu}�ol O�vnedContractodAulhorized Ac�enl Date <br />