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P�RMIT APPLICATIt�nl <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257 3810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 9 .—/— �g <br /> SITE ADDRESS PARCEL TAl(I.D.A� PERMIT N <br /> 7i 3 a v ��•n p , c 3� ✓L, -� <br /> LEGA LOT NO. BLOCK TRACT�`R SUBDIVISION N <br /> DESC. <br /> OWNER ADDRE$S CITY2IP PHONE <br /> G c,�r-�EEcHL 7i 3a D��'"'�pi c �2 6vr. 9fzo3 yzr3S3383� <br /> TENANT NAME I COHTACT FOR PERMIT PHONE <br /> E*INL <br /> So�..�p oi� Co, G3 y6 ✓La�^'�c�`' fi'< <br /> CONTR.LICENSEp s�• S� �ZO�i•rZS L3 OO <br /> so�.�D o c , ��'f r..+►4 ,,���Lpq 9��i8' <br /> USE OF BUILDING NEAT SOURCE CONTRACT PRICE OF WORK <br /> /��S� Electric Gas �ther Fj ys0, a' <br /> — — — i <br /> WORK DESCRIPTION <br /> JN5T�Y1� /-�E-f�'T �O✓�^^ �p <br /> PLUMBING MECHANICAL . <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Bathiub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 disposal � Gas(ireplace <br /> Dishwashor Gas range <br /> Clothes washer Clolhes dryer <br /> Watur heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust(an <br /> Backflow preventer � Heat pump <br /> Urinal Unil heater <br /> Drinkin� Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease Irap _ Woodslove <br /> Roof drains Other _ <br /> Other <br /> i <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this applicalion and know the same to be true and cortect. All provisions of laws and <br /> ordinaces goveming this type ol work will be complied with whether speci(ied herein or nol.The granling of a pertnil does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulaling conslrudion or the perfortnance ot <br /> construction.Thal I am aulhorized by the owner of Ihis property to periorm the work(or which application is mede and I comply with the <br /> State Coniractors Law 18.27 RCW and 296.200 AC. <br /> �t - 1- Oq <br /> Signalure of Owner/Conir lor io ' Agent Date <br />