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PCRMIT ApPLICATIUN <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.# PERMIT# <br /> � , ,vl�U'�� C''J`\ <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ` ADDRESS CITY2IP PFiONE � <br /> TEN_���/�xJ 77G(9COL AC��i EP RMI� ��P�L��i�'4 PHO��Z�� <br /> —�� /.-, A o.-s�_.,..� L�.f 2.f/D �,.Q ��'� - <br /> CONTRACTOR ` J,��� ��� ADDRESS CITY2IP PHONE <br /> Y/ �` <br /> CONTR.L�CENSE# LI ZS,�S Zy/f/ <br /> / <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> � _Electric _Gas_Other 1j' /,.$'U U f -' _ <br /> WORK DESCRIPTION <br /> �,lyr��l6��o--�r� � �'ae,���� �� <br /> PLUMBING MECHANICAL <br /> N0. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �, A/C-air handling units <br /> Toilet <br /> BalhWb Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washor Clolhes dryer <br /> r� Waler healer _ Rango hood <br /> Sink(service/bar/mop/etc.) _ Exhaustfan <br /> Back(low preventer _ Heal pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OP EVERETT tOCAL SALES TAX CODE IS 3705 <br /> I hereby ceriiify thal I have read and examined lhis application and know lhe seme to be true and correcl. All provisions o(laws and <br /> ordinaces governing lhis lype of work will be complied wilh whother speciTiod herein or nol.Tho granling of a permil does not presume <br /> lo give authority lo violalc+or cancel lhe�mvision of any olher slale or local law regulaling conslruction or the performance of <br /> construclion.That I am authorized by lhe owner of lhis property lo periorm lhe wotk for which applicalion is made and I comply with lhe <br /> State Contractors Law 18.27 RCW and 2°6200 WAC. <br /> .�QIG��> �a,�d'fo� �//�iv6 <br /> ' ignature o(OwnedC lractodAuthonzed Agent at <br />