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� <br /> . PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8657—vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 4_ �6_�a <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> /z29 �• N'I�.e%u� V/�1t�1�,e 0��3�3 �299-OD8- OD too - vvZ <br /> DESC. LOT NQ. �Z�LO* � TRA�V�n BDIVISIONAJ V o P�r <br /> 6 I� �G <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> ��-�� �or�ui e� ��,�sr��no,t�),�1G �'IG�'�l Sv�ll� <br /> TENANT NAME CONTACT FOR PE/R�MIT PHONE � �i�.-5�37 <br /> �/W��C� T!/�/�'v"�JO� E-MAIL <br /> ��-��oc�urn y �or�urr�jR otiS j ,���ysV�ll�, h�A� <br /> CONTR.LICENS 8 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � _Electric _Gas_Olher �� dQ� <br /> WORK DESCRIPTION �y „ ^ � <br /> L/v l <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Ba!htub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas Tireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(servicelbar/mop/elcJ Exhausl fan <br /> Backflow preventer Heat pump <br /> Urinal Unit hea�er <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify ihat I have read and examined lhis application and know lhe same to be true and correcl. All provisions of laws and <br /> ordinances governing this type of work�vill complied with whether specified lierein or nol. The granting of a permit does not presume <br /> (o give auth rity�o violale or cance ihe pr ision of any other slate or local law regulatiiig construction or the performance of <br /> co cti .That I am authoriz by ih wner of this propehy to perform the work forwhich application is made and 1 comply wilh the <br /> ate C Iractors Law 18.77 R W and 6200 AC. <br /> - �� 9 ��5��% <br /> Si iat r wnerl o ctor/Authori e AgeN Date <br /> --��- — ---- — ----- ---------- <br />