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—� <br /> PtRMIT APPLICATIbN <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.# P RMIT# <br /> �i�0 I A _C S l�re �b y 3`I I �o q v o � o o � :�D - s� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ����� ��-�-�e a i�o I o�-�s !� �.� ya s ���� �y9�y <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � ���ICN�`i'�L <fdS' . zl - 333 <br /> CONTRACTOR ��-Gp ADDRESS CITY2IP PMONE <br /> 1�y47 i?C�� �.e. n1� 4�S= FSzi -3333 <br /> CONTR.LICENSEfI �D�CCI �G7-1 O� �� �Zr�a 9 ko�3 <br /> / <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �r�� _Electric �['Gas_�ther �f S D"D ' � <br /> WORK DESCRIPTION <br /> �-.�-d--P,l 35, ap,.� �Tl.c � �uo--c_a� �.c.�.���-�. <br /> �C� ,�-r� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OP FIXTURE OR Il eM <br /> Toilet AlC—air handling unils <br /> Balhtub � Forced air systems <br /> Lavalory(wash basin) � Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry lray _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Back(low preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodslove <br /> Ruof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby cerilify th�t I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces governi��g this type of work wilt be complied with�vhelher specified herein or not.The granling of a permil does nol p�esume <br /> to give authority to violale or cancel the p wsion of any other stale or local law regwating consWction or the pertormance of <br /> conslruction.That I am autnorized by th owner o(lhis property lo pedorm lhe work tor which applicalion is made and I comply with lhe <br /> Stale CoNractors Law 1827 RCW an 296.200 WAC. <br /> � ��3�/� <br /> �ignature of O�vnedContr ctor/Authonzed Agent Da�e <br /> __._. - / <br /> �� <br />