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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SE�3VICES <br /> 3200 CEDAR STREET, EVERETT, �NA 98201 <br /> 425-257-8610—FAX 425-257-8857—ww.v.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADORESS � PARCEL TAX I.D.7K PERY.r . ; <br /> a o r�eiv;� l��e n ou5 yv� v�vu1 �oZ G 5. ' — 3l� <br /> LEGA LOTNO. BLOCK TRACT <br /> oesc. � � �-13 ly p�v2 - Pl.r+r }�; �e ti�{St <br /> OWNER ADDRESS CITY2IP PHONE <br /> �ev�dvrCw Cun��+vr5 �o. �) ox o2��/3 E�exf{- 981r3 yzs• &��- 72y7 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> /�lA+�- (�tC Ic <br /> CONTRACTOR �DDRESS CITY2IP PHONE <br /> Scn,nciv;cv Cv�4-rc c�Furj o 3u� a�4? ���'cfi- vZS• F17U� 7� y '] <br /> COaTR.LICENSE N 9Fzi 3 <br /> �Uun1lJCL �i51 k c� <br /> USE OF BUILDING HEAT SOURCE �ONTRACT PRICE OF WORK <br /> Sr- � _Electric �Gas_Other I 1�dj GC'J(J <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet A/C—airhandlingunits <br /> � Bathtub Forced air systems <br /> � Lavatory(wash basin) � Gas piping <br /> Shower � Waterhealer <br /> � Kitchen sink 8 disposat � Gas fireplace <br /> I Dishwasher l Gas range <br /> 1 Clothes washer ,� Cbthes dryer <br /> = Waler healer � Range hood <br /> Sink(service/bar/mop/etc.) Ezhaust tan <br /> Backflow prevenler Heat pump <br /> Urinal Unil heater <br /> Drinking Founfain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodslove <br /> Root drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y fhal I have read and examined Ihis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing lhis typo of work will be complied with whether specified herein or not.The granting of a pertnit does nol presume <br /> ro give aulhorily to violale or ca provision of any other state or Iocai law regulating wnstruction or the performance of <br /> construction.Thal I a �y lhe owner of this property to pedorm lhe work for which application is made and I comply with the <br /> Slate Contra� 7 RCW and 296.200 WAC. <br /> �� . ���_ �2 •.2 I-GS� <br /> � Signature o(OwnedContrector/Aulhorized Agent Date � <br /> �L <br />