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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 S—D�-—o�] ' <br /> 425-257-8810— FAX 425-257-8857—www,everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM PU� ����J <br /> SITE ADDRESS �� �)`�(���7�L PARCEL TAX I.D.# PERMIT# <br /> '�w z C o - o/o <br /> L'cGAL LOT NO. BLOCK TRACT <br /> D'cSC. <br /> OWNER AODRESS CITY2IP PHONE <br /> 1'i�'�c.,"C! �urLDck'S d�l�:- <br /> TENANT NAMF. CONTACT FOR PERMIT PHONE <br /> ' � . �lZ lG ,��ltlZ� h.� �/Z5 •c��0 —�ZO�.�• . <br /> CONTRAC7UR` ♦�+ +^ ADORESS ' ' CITY2IP PHONE <br /> !��,z �s��,L�esQ� a�ylO `l2�o�UE NC� <br /> CONTR.UCENS�M . i - SG� C'`�^ I�7�� . •�D'���1�� <br /> j�t����/C,��' �-��,�w�,� . � �SZg� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> s�� _Electric �Gas_Olher <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXiURE OR ITEM <br /> � Toilel A/C—air handlin�units <br /> f Bathtub I Forced air systems <br /> � Lavatory(wash basin) � Gas piping <br /> �_ Shower Walerheatar <br /> 1 Kitchen sink&disposai � Gas firep�ace <br /> � Dishwasher Gasrange <br /> � Clothes vasher ,_,_(_ Clothes dryer <br /> � Walc�r heater ( Range hood <br /> Sink(servicoNadmop/otc.) � Exhaust fan <br /> Backflow provenler Heat pump <br /> Urinal Unit heater <br /> Drinki�g Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Othor <br /> Other <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 7105 <br /> I hereby cerilify that I havo read and examined lhis application and know lhe same to be lrue and correct. All provisions of laws and <br /> ordinacos governing this lype of il�be complied wilh whether specified herein or not.Tho granting of a permit does not presume <br /> to give authoriry to v' lat nce o pr on of any other slate or local law regulating construction or the perfortnance ot <br /> construction.Tha m aulh riz by lh nor ot lhis property to periorm the work for which application is made and I comply with the <br /> utale Contr w 18.2�RC 9fi.200 WAC. <br /> �— � S� � <br /> Sic�nature o wnedConir IAuthorized A�ent ate � <br /> ��2 <br />