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PtRMIT APPLICATIC�N <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 PARCEL TAX I.D.# E IT N <br /> 222� DAKES VE• oo�3ql — h?-L -OIti - Op �a _. 41 <br /> LEGA LOTNO. BLOCK TRACT <br /> oEs�. i� + I5 �-i�� �,�`iT oF �V�RE i rt <br /> OWNER ADDRESS CITY2IP PHONE <br /> �l o4�N FI U�L-. 2�-2�- Op�kE� /�VE �VL p_.�7T�qgZDl ����q9-25GG <br /> TENANTNAME CONTACTFORPERMIT PHONE� <br /> I�t1N }{UI.L (2«0� �q� -25�G <br /> CONTRACTOR ADDRESS CITYlZIP PHONE <br /> CONTR.LICENSE# —� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �' k��' C _Eleclric _Gas,�Other �E � <br /> WORK DESCRIPTION <br /> ��tiovc Cx�s� iN�, Co�c.�.�te pl�p � Bull-D N�W G�i��c= <br /> Z�X �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIX7URE OR ITEM <br /> Toiiel A/C—air handling units <br /> Bathtub Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/moplelc.) Exhaust tan <br /> Backflow prevenler Heatpump <br /> Urinal Unit heater <br /> Drinking Founlain Boiier <br /> Floor drain Refrigeralion <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this application and know the same to be true and cortecl. All provisions of laws and <br /> ordinaces goveminc� lhis type o(work wili be complied wilh whelher specified herein or noL The granting of a pertnil does not presume <br /> lo give aulhority to viol te or cancel the provision of any other stale or local law regulating construction or lhe performance o( <br /> construclion.Tha 1 a aulhorized by lhe owner of lhis propeAy lo peAorm the work tor which application is made and I comply with lhe <br /> Stale Contra� 8.27 RCW and 296.200 WAC. <br /> IDI�IID� <br /> Signalure of Own J niractorlAulhorized Agent at�— �/� <br />