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� PERMIT APPLICATIC)N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ��1„Z <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org �! U� <br /> A P P L I C A T I O N S A R E A C C E P T E D F R O M 8 A M T O 4 P M � G <br /> SITE ADDRESS � PARCEL TAX I.D.# PEkM1T# <br /> ��t2Fa r. <br /> /o �;a� ,�w �2 00 3 on�� C� -- <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER f ADDRESS CITY2IP PHONE <br /> S�rE��e.J �-I J u,.�,�a . (�0 t5o�(, 'aC�9 I �o Ee�Tr (-ti�. p8�13. <br /> TENANT NAME CONTACT�oR PERMIT PHONE <br /> I �d,nl �..�ANJIL �C+PRir��F2. ..�Ut�A ��oflQiC�U't4.. �/.4S 210 8� 53. <br /> E�uIAlL <br /> ��h I I P <br /> CONTR.LICENSE# <br /> USE OF BUILDING HE T UqCE CON7RACT PRICE OF WORK <br /> I �� (,�/YLI� ('It!�hd/ <br /> Eleclric _Gas_Other v(�r n9G� <br /> WORK DESCRIPTION <br /> �urF,�s,�� �� �,�cncf � /`��cEs��;! 2��•cc. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTIIRE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �_ Toilcl A/C—air handling units <br /> Ba�hlub Forced air systems <br /> n -Lavatory(wash basin) Gas piping <br /> / Showor /� Waler heater <br /> � Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> lothes washer Clothes dryer <br /> i�Naler heater Range hood <br /> ISink(service/bar/mop/elc.) � Exhaust fan <br /> � Backflow preventer Heal pump <br /> Urinal Unil healer <br /> Drinking Fountain Boiler <br /> Floor drain � Refrigeralion <br /> Grease lrap Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> 1 hereby cerili(y thal I have read and examined lhi� �oplicalion and know the same to be true and correcl. All provisions of laws and <br /> ordinaces goveming this rype of work will be com, ,J wilh whether specified herein or nol The c�ranling of a permit does nol presume <br /> to give aulhoriry to violate or cancel ihe provision of any olher state or local law regulating construction or the performance of <br /> construction.That I am authoriz d by ihe o�vner ol lhis property to perform thc work(or�vhich application is made and I comply with the <br /> Stale CoNraclors Law 1 h and 296.200 WAC. <br /> - ;� -� s - n <br /> SignaWre of Own AAuthorized A�ent Date I/ <br /> ' � <br />