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P�RMIT APPLICATI(�N <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 6 _ j� �O� <br /> � '� <br /> SITE ADDRESS / PARCEL TAX I.D.# PERMIT# <br /> � l �4-��S ��I°(r - L�O� <br /> LEGAL LOT NO. BLO(:K TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> w <br /> � ��.�� !��S ��� '��—� !� - � � � t� Q���o� �s?� <br /> TENANT NAME C�NTAC�FQR P�RMIT�,\ + N� _ PHONE �.�-S–3 /� /n � <br /> , I. <br /> C v�� S '� �.�� �� !�l(�R e-ma� S"�S 3•' <br /> coNrR�� R nooRes� irvrziP <br /> CONTR.LICENSE# <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF`V�ORK <br /> Eledric Gas_Other S � �J� <br /> WORK DESCRIPTION l, ����� �_� L �`L�i�j ����, C-��;C� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilel A/C–air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kitchen sink 3 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink(servicelbadmop/etc.) _ Exhausl fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unil heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodslove <br /> Root drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined lhis application and know the same lo be hue and correcl. All provisions of laws and <br /> ordinaces c�overning this type of work will be complied wilh whelher speci(ied herein or nol The granting of a permil does not presume <br /> lo give aulhonly lo violate or c�ncel ihe provision o(any olher stale or local Iaw regulating consWclion or the pedormance o( <br /> construclion.Thal I am authorized by lhe owner of lhis property lo pedorm lhe work for which applicalion is made and I comply wilh the <br /> State Conlractors Law 1827 RCW and 296.200 WAC. <br /> \\•`�� �s:��'���.u���;� ��G.��— <br /> Signature of y�edConUactor/Authonzed Agent DaTe <br /> � <br />