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, <br /> P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, W 4 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE AD[iRESS PARCEL TAX I.D.# I PERMIT# <br /> � � y < <O •�. _ ' 1j � G�-o Z <br /> LEGA LOT NO. BLOCK TRACT .--�f <br /> DESC. � G }� � �{-k ; I I • <br /> OWNER ADDRESS I 21P PHONE L� 7t��. <br /> �Uon u)���—��� � �f��{ �� 3��� S1{,r,u L��,�, �.,�c� L.�/� ��t�".� <br /> TENANT Nq �� I CONTACT FOR PERMIi � PHONE <br /> �s�C (�'�a( � � — <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas_Olher <br /> WORK DESCRIPTION <br /> �� ��l C( I S � C]-L�r�l�(,C. � <br /> �� � <br /> I PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C—airhandlingunils <br /> Bathtub _ Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ �Naler heater <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Laundry lray _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhausl fan <br /> Eackflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease Irap _ Woodstove <br /> Roof drains Olher <br /> Other — <br /> CITY OF EVERETf L7CAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this application and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied wiPi whether specified herein or not.The granting ot a permit does not presume <br /> to give aulhonty lo violale or cancel the provision of any nther slale or local law regulating c�nstruction or the pertormance of <br /> construction.That I am aulhorized by the owner of this property to perform the work for which application is made and I comply with the <br /> Slale Cv„traclors Law 1827 RCW antl 290. 00 WAC. <br /> � � � <br /> ��%� �l'1 � �1• '1 7—��'� � � <br /> Si natura o wn dContracror/Aulhonze Agenl Dale / � <br />