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F ERMIT APPLICAT�vN <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.M PERMIT 11 , <br /> I �C �; r%/-1u��'IC. �vE:� OO�o r 1 180IZOO I ��"`;z'y - '' <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDNISION N � <br /> DESC. SEt ,d11"AG-�L 1� <br /> OWNER ADDRESS CITY2IP PHONE <br /> j����l v��i� ���1✓�(' ��G�. L.i� po p�o�/. szk7 �V�R�i �A q�2oC� �Zb f 2.SZ."�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE ^.Z��.7 4z_ �93 <br /> !Z^�J��� `-1 <br /> � C u�/ E�MAIL <br /> QW��d��;f <br /> CONTR.LICENSE!i <br /> USE OF BUILD�NG I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��7t�1��1 L-I�`� I r.; �... I _Electric _Gas_Olher <br /> � <br /> WORK DESCRIPTION <br /> -vE�r�t�:;�I :;��'- ���=�,�,x zqe!' �, iT � �LI sC' 'f3�i ��i N G <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink(serviceNar/mop/etc.) Exhausl fan <br /> Backfiow preventer _ Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> I hereby ceriti(y lhal I have read and examined this application and know lhe same to�e true and correcl. All provisions ot laws and <br /> ordinaces goveming Ihis type of work will be complied with whether specified herein or not.The granling of a permit does nol presume <br /> lo give authority to violate or cancel the provision of any other state or local law regulating construction or lhe performance of <br /> conslruction.Thal f am authorized by the owner of lhis property to periorm the work for which applica:ion is made and I wmply with the <br /> Stale Contractnrs Law �8.2�RCW�a�d 296.200 WAC. <br /> � ;_ ��I ��� <br /> ,_. <br /> Signature ol OwnedConlractodAulhorized Agent Date <br />