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�ERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org I <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I' <br /> SITE ADDRESS PARCEL TAX I.D.M P�RMIT M � <br /> � p � s"� MpN� �J�� /da �.Slld -� (v <br /> LEGA LOT NO. BLOCK TRACT I� <br /> DESC. _ �� h <br /> OWNER � ` � u/v� I� <br /> ���Qr/� /� ���N,�� ADDRESS CITY2IP PHONEyzf-3t7- 7 c� <br /> / <br /> � <br /> —�/fR/�'.p-RA- L. 6'/Q�/idiFit .2/�/5�/Hu,vRU� /}v2 /z/.r,li-uT y,rr..2o3 <br /> IENANT NAME CONTACT FOR PERMIT PHONE � <br /> ��� � <br /> CONTRACTOR ADORESS CITY2IP PHONE � <br /> � <br /> CONTR.LICENSE N �. �,�,�J <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Electric Gas Olher j3�� <br /> WORK DESCRIPTIOk ��r C L G �i=�/� C�� ����T�� ` ,���,�,` <br /> ' i� <br /> l5 x �3 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toile: A/C—air handling unils <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink(servicc/barlmopletc.) Exhausl fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that i have read and examined lhis application and know Uie same lo be true and correcl. A�I provisions of laws and ', <br /> ordinaces governing this lype of work will be complied wilh whelher speci(ied herein or noL The granting o(a permit does not presume ' <br /> to�ive authorily to violate or cancel the provision of any olher state or local law regulaling construction or the perfortnance of <br /> cor�truction.That I am authorized by the owner o(this propeRy to perform the work for which ayplication is made and I comply with ihe <br /> Slate Contractors L:w 18.27 RCW and 296200 WAC. <br /> H�/�/��D� <br /> Signalure of Owner/ContractodAuthorized Agent � Date <br /> tjl <br />