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P�:F:MIT APPLICATIt��J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810•- FAX 425-257-8857 -www.everetlwa.org <br /> APPLICATIONS AftE ACCEPTED FROM 8�+M TO 4 PM 3 -a�{�D� <br /> SITE ADDRESS PARC TAX I.D.# P RMIT if <br /> /�� �/.�:'.•;ri,�c U,i�,.. �v y'00/G o>�-�D '/UD � �0� -(�?5d� <br /> LEGAL LOT NO. � BLOC� TRACT OR SUB IVISION# <br /> DESC.� <br /> OWNER '.DDRESS CITV2IP PHONE <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �, _., �ao( `Do� / %�.5' 330 �d7� <br /> '� 0,6 �.,�/��/ �_� T:�/�v e-Ma� <br /> �� � <br /> �� TLcf�� �l/7 %s��,OR� S/b� cv� YZ5'33a-727� <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> n <br /> '{ S�� �� �Eleciric _Gas_Olher <br /> v <br /> WORK DESCRIPT�ON <br /> J`�d0�( Uf' ��`aJea �- Gt��s �j n ) <br /> ;. �a�v�t �._ �o�o�-a� G � (G <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilel A/C—air handlinc� units <br /> Balhtub Forced air syslems <br /> � �_ Lavalory(wash basin) _ Gas niping <br /> Shower W aler heater <br /> Kilchen sink&disposal _ Gas(ireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(servico/bar/mop/elc.) _ Exhaust fan ' <br /> t3ackllow preventer _ Heat pump <br /> Ur�..al Unit heater <br /> Drinkinc� Founlain _ Boiler <br /> Floor drain Re(rigeralion <br /> Grease lrap _ Woodslove <br /> Root drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this application and know lhe same to be true and correct. All provisions oi laws and <br /> oidinaces c�oveming this type o(work will bc complied wilh whether specitied herein or noL The granling of a permit does not presume <br /> lo give aulhorily to violate or cancel lhe orovision of any other state or local law regulating conslruction or the performance of <br /> conslruclion. Thal�am aulhorized by the owner of this property lo perform the work for which applicalion is made and i comply with lhe <br /> Stale Contraclors Law 18.27 RCW and 296.200 WAC. <br /> ::; ) L/��' 2—,j� <br /> Signalure o(O�vnedContraclo I uthonzed Agent Date <br /> I - ��L <br />