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PtRMIT �►PPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-E810—FAX 425-257-885 i—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT�k <br /> '"�3�o r���-oc17,��n� rvT �ill ZQ 8 � ��o - �3 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ;'�irr..��fP�fk oNt�P�I+ 9�a-o N�At�� wky �'e�ir `��' 3Sq -L16� <br /> 7ENANTNAME I CONTACTFORPERMIT PHONE <br /> �i"a M <br /> CONTRACTOP...F:.,i/�;Cy{�.V 'D i:a����- ADDRESS �Ilo �I,��rr� CITY2IP PHONE <br /> TU°Ivlc.�V .i) I�v�7 �V'I -1 7 .�1c <br /> CONTR.UCENSE# , � b y�3 �K ���"� <br /> �'17��'�iRSnIG' �' <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> C��� _Electric _Gas_Other ���G�p 0, <br /> = <br /> WORK DESCRIPTION •-�� C� � Ld,��, •�GC'F I�✓y� INST�qi[ � L v��. �(�J�✓�- <br /> . � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C-airhandlingunils <br /> Bathtub __ Forcedairsystems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Water healer <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer Clolhes dryer <br /> Wator heater � Range hood <br /> Sink(service/badmoplelc.) _ Exhaustfan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Dnnking Founlain Boiler <br /> Floordrain _ Refrigeration <br /> Greaso trap _ Woodstove <br /> Roof drains _ Olher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> I hereby ceriti y that I have read and examined this application and know the same to be true and cortect. All prov�sions of laws and <br /> ordinaces goceming this type of work will be complied wilh whether specified herein or nol.The granting o(a permil does not presume <br /> to give authoriry lo violale or cancel the provision of any other stale or local law regulating wnstruction or the perfnrmance o( <br /> conslru��on.Thal I am aulhorized by the owner ol lhis property to peAorm the work for which application is made and I comply wilh the <br /> State Contrac rs Law 18.27 RCW and 296.200 WAC. <br /> ��.{,�'1.�, � `�����7 <br /> SignatUr o OwnedConlraclor/Aulhonzed Agenl a�e <br /> v <br />