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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERET i, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS ��� �� PARCEL TAK I.D.# PERFIIT N <br /> �' � � I �r' �`�'�� _ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �RU �V�it-�P'rt��/�/f � C�n1���ua7°N �6. Qox �Z32� � F�r:��L��,�j� l �i8� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Nc�� �oKnl �a�S�� c,l'LS - Z3Z- < <ISZ <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSEft �oF pC.Rt� 2o c_ <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> MuL� �'�'s��y EleMric �Ga� Olher <br /> WORK DESCRIPTION <br /> t7�if7��USH E XI5�7..�1, 5F�- rin�0 �M�6� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FU(TURE OR IT�11 <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower !� Walerheater <br /> Kitchen sink&disposal � Gas fireplace <br /> Oishwasher Gas range <br /> Cblhes washer Clothes dryer <br /> Water heater � Range hood <br /> Sink(servicelbarlmop/etc.) � Exhaust tan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeretion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritiry that I have read and examinod lhis application and know the same to be true and correct. All provi,fons of laws and <br /> ordinaces goveming this type of work wi�l be complied with whelher specifiad herein or not.The granting of a pertnit does not presume <br /> lo give authority to violale or cancel ihe provision of any other state or local law regulating construcQnn or the perfortnance of <br /> construction.That I am authorized by the owner of this propeKy to perforr�the work ior which applic.Jon Is made and I comply with lhe <br /> State Contractors LaW( 1�Q.27 pRCW and 296.200 WAC. <br /> � \ \ _-� L`I'?_ o� <br /> SignaWre of�fw iedCont Authonzed Agent Date <br /> 11 <br /> � � <br /> - .� <br />