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P�RMIT APPLICATIC.�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMlT IF <br /> 0 <br /> .�Iti' ��clil �Z � g �.0 Q —� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY(LIP PHONE ��3/99� <br /> ,Li�„� �`���,�; �-/�, 7� �,Upi��,FUy�w 6�� �`� �-r�r�a� <br /> TENANTNAME I ���iA/T��R��1T oHONE / <br /> �2��Z��� <br /> CONTRACTOR AODRESS CITY2IP PHONE <br /> CONTR.LICENSE p ��� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � L> � � J l i��� �Q�I W I �4 Electric �Gas_Othe• I <br /> V�ORK D/�SC�R—I/P'TION Q <br /> ,�t,?Q� /'�OD� ��G{ i���iC/ <br /> ��� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet A/C—air handling units <br /> �.�C Bathtub � Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> � Shower � Waterheater <br /> � Kitchen sink&disposal Gas tireplace <br /> .� Dishwasher Gasrange <br /> � Clothes washer Clolhes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/bar/mop/elc.) a� Exhausl fan <br /> BackOow preventer Heat pump <br /> Urinal Unil healer <br /> Drinking Founlain Boiler <br /> Floor drain Retrigeralion <br /> _ Grease lrap Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> I hereby ceritify that I have read and examined lhis application and know the same to be true and cortecL All provisions of laws and <br /> ordinaces governinc�this lype of work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> to give au�horily to violate or concel the provision of any other stale or local law regulaling constructlon or the performance ot <br /> construction.That I am authorized by lhe owner of this property to pertorm the work for which application is made and I comply with the <br /> Slate C�l�aictors Law 18�7�#2CW and 296.200 WAC. OC� �/ O� <br /> N) I / �'1 �� � ) <br /> �;h i� �� u u.,.� <br /> SgnHture of OwnedContraclor/Aulhorized Agent Dale <br /> i� <br />