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PtRMIT APPLICATION <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEI TAX I.D.�M I ER�O� D 1 <br /> �3►0 o c,�S a�� ' 2 <br /> LEGAL LOTNO. BLOCK TRACT OO C+SOCo �-$ 1 a�O O� <br /> DESC. <br /> OWVER ADDRESS CITY2IP PHON��`_y�,3 <br /> �Rtr,h��c � ���C M.L.�1�'A�- C-�Tn'�. L'd 0.u, A�J �t�l <br /> TENANT NAME CONTACT FOR PERMIT PHO E <br /> �'�c� {�Cac�� ��a) 3�I�a- o�,0-7 <br /> CONTRACTOR Ur'LD t0s Sj�O t:i' CITY2IP PHONE <br /> a�,�. P��.po�� C�. c. �'�'r' �ib'�`t ��)�9�-���-� <br /> CONTR.UCENSE p w 1 I ^vU��I �� <br /> r'��L�1.�1 <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCR�PTION <br /> �`2�G� L�\ST1 N � -�y�L <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR Il EM NO. 'YPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> _ Bathlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry lray Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> BackOow preventer Heatpump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floordrain Retrigeretion <br /> Grease lrap Woodstovo <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAIC CODE IS 3105 <br /> I hereby cerilify thal i have read and examined this applicalion and know lhe same to be lrue and correct. All provisions of laws and <br /> ordinaces goveming this lype of work will be complied wilh whelher specified herein or not The grantlng of a permil does not presume <br /> to give authoriry lo violale or cancel the provision of any other state or local law regulating consWclion or the perfortnance of <br /> construction. m author'zed by the owner oi this property to perform the work for which applicalion is made and I comply with lhe <br /> Stale Con ctor L 827 CW and 296.200 WAC. <br /> � �i <br /> Sic�natu of OwnedC or/Authorize gent Da e <br />