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PCRMIT APPLICATION <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.K PERGIIT�I <br /> �0 :,. � O - O <br /> IEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWHER ADDRESS CITY2IP PHONE [.��_&'7a-]Zy <br /> �un�V;�u C�,�+C��i4rS �u L�x �cr�(3 tuuLFf wA 98213 <br /> TENANTNAME CONTACTFORPERMiT PHONE <br /> CONTRACTOR SUJr�Ui eU C�v� �'f��1ti�A0DRE55 CITY2IP PNONE <br /> CONTR.UCENSE N <br /> Sou�d c L 5 S� k :� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��Mo1; ��V� _Elec'ric _Gas,_Other <br /> i <br /> WORK DESCR�PTION <br /> '�L/Y\�'1 �- '� � �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTIIRE OR ITEM <br /> T� let A/C-air handling units <br /> B,.tiriub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 disposal Gas(ireplace <br /> Dishwasher fas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> BackBow prevenler Heat pump <br /> Urinal Unil heater <br /> Drinking fountain Boi�er <br /> Floor drain Re(rigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVEREtt LOCAL SALES TAX CODE IS 3105 ` <br /> I hereby ceritify Ihat I have read and examined this applicafon„nd know Ihe same to be Irue and correcl All provisions of'aws and <br /> ordinaces governing this type o(work will be complied wilh whelher specified herein or noL The granting o(a permit does not presume <br /> to give authority to viol�te or cancel Ihe provision ot any other s',ate or local law regulaling conslruction or the periormance of <br /> consiruction."fhat 1 am authorized by ihe owne�ol lhis properly to periorm lhe work tor whirh application is made and I comply with the <br /> Stale Conlraclors Law 18.27 RCW and 296.200 W�C. <br /> 3�/S/D � <br /> SignaWre of OwnedContrectodAuthonzed AgeN �f�ate <br />