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P�RMIT APPI.IC�TI(�nl <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org ,, )�jti/_�D�� <br /> �/U �J�// <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.7f PFjR�AIT A <br /> ;'C> ^3d' �r, � ,�r/� �Ve 3969vwosatoo� � ( ,'S�].`7 3� <br /> LEGA LOTNO. BLOCK TRACT _/ ,/ <br /> DESC. �� ,�iPCClyuf4 .�E'S� /� <br /> OWNER ADDRESS CITY2IP PXONE <br /> ��� y , ��S � ,�� /f'Icr�-YS v. %/p �vA ��a�� <br /> TENANT NAME CONTACT FOR PERMIT PIIONE <br /> %d�y�.� �..�Y��'y ��.�6,�� �k,�, ����'�7��� <br /> , <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> �;a��se /t� <br /> CONTR.LICENSE k <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> I-Csi<�c'�r%!4� C'�rrs!/l4� � <br /> ElecMc �Gas Olher <br /> WORK DESCRIPTION /, /�1�1 �C//� — <br /> C'iC�ll)�'�:Y�^ �p SL�iI���� T T 7 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM � NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet AIC-air handling unils <br /> �_ Bathfub � Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> „�_ Shower � Walerheater <br /> _L Kitchen sink 8 disposal Gas fireplace <br /> _L Dishwasher Gas range <br /> i Clolhes washer � Clolhes dryer <br /> _ Laundry tray � Range hood <br /> Sink(servicelbar/mop/etc.) Exhaust fan <br /> BackOow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain �_ Boiler <br /> _ Floordrain � Refrigeration <br /> Greaso trap Woodstove <br /> Roo(drains Olher <br /> ' Other <br /> CITY OF EVERETT LOCAL SALES TA7C CODE IS 3705 <br /> I hereby cerili(y lhal I have read and examined this appiicalion and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces governing lhis lype of work will be complied wilh whelher specified herein or not.The granting of a permit does not presume <br /> to give aulhority to violate or cancel the provision of any other state or local law regulating constructlon or the perfortnanco of <br /> construction.That 1 am authorized by the owner o(this property to perfortn the work for which application is made and I comply with lhe <br /> Slate Contractors Law 18.27 RCW and 296.200 WAC. <br /> � �`��j� 5-�- oS <br /> Signature of OwnedContractor/Authonzed Agent Date (� <br /> Z <br />