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' I�ERIIAIT APPLICATI�IN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> •125-257-8810— FAX 425-257-8857—wvuw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.� PE MI <br /> �i x�0 1"/! v��l� C'rte 1� w i�tIDO d �� _� <br /> LEGA LOT N0. BLO K TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER AUDRESS CITY2IP PHONE �20��3�$--77 7 <br /> ��'�s�,.-.��n , 1Zu,� Es�.�C l�ald�-�,�I,L �coa �nnl�o5;�/ f� S!c 2S2c) Sc��k,ulr� 9J'Io! <br /> TENANT NAME CONTACT FOR PERMIT PHONE (y'Z5�775--74�I�/ <br /> CrtC IY�(/US��t�� �-4.� I .T�'-� PLy-?w'SU.-� EMAIL �YGYS�rEi C✓fJ-Iq c��r <br /> , <br /> �dFITRAt, �$ �n� <br /> C�w I„d�s 1�;<•i �-.-h <br /> CONTR.LICENSEpS�C��V..`L�1f" cl4bL� V3�c Y'1ev�;ll C�'tek PKw� ��2�, W,� (H25� )75-7vy/ <br /> �uoo 98a�3 <br /> USE OF BUILDING I — HEAT SOURCE I CONT,�ACT PRICE OF WORK <br /> Eleclric Gas_Other / � ��" -�-�r(,� <br /> WORK DESCRIPTION <br /> ��,�`�c,.�i .y �i�i--. <br /> � d <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FUCTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas ranc�e <br /> Clothes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust 1an <br /> Backllow preveMer _ Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Doiler <br /> Floor drain Retrigeration <br /> Grease lrap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceritify that I have read and examined Ihis applicalion and know the same to be true and correcL All provisions of laws and <br /> ordinaces goveming this rype of work will be complied wilh whether specified herein or not.The granling of a permit does not presume <br /> tc c�ive aulhority to violate or cancel lhe provision of any olher stale or local law regulatinq construction or the performance ot <br /> construction. That I am authorized by Ihe owner of ihis property to perlorm the work for�thich application is made and I comply with ihe <br /> State Coniractors Law 18.27 RCW and 296.200 WAC. <br /> ia�a9/08' <br /> Signature of OwnedCoNractodAulhorized Agent at� <br /> ��� I <br />