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PtRMIT APPLICATIC�N <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 ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# 'P,ERMj�T,# <br /> / � 1M - � � �Y1 U� �� — , <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ��;1 �� �' n� �/I..� c-ii�Q� II . 1���� 0�4Z_ <br /> TENANT NAME C� A T FOR PERMIT PHONE <br /> �, 7 <br /> CONTRAC R � '1 L�• ADDRESS CITY2IP PHONE <br /> �.�•`ILc <br /> CONTR.LICENSE p <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric �,Gas_Other <br /> WORK DESCRIPTION <br /> �� <br /> ���-�>. �� � �� I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> Toilet A/C—air handling units <br /> Balhtub Forced air syslems <br /> Lavatory(wash basin) � Gas piping <br /> Shower 1 Waterhealer <br /> Kitchen sink&disposal 1 Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Waler heatcr Range hood <br /> Sink(service/badmop/elc.) _ Exhaust fan <br /> 6ackllow prevenler _ Heal pump <br /> Urinal Unil healer <br /> Drinkinc� �ounlain _ Boiler <br /> Floor drain Re(rigeration <br /> Groase lrap _ Woodstove <br /> Roo(drains Olher <br /> Other _ — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this application and know the same lo be true and correcl. All provisions of laws and <br /> ordinaces governing lhis type of work will be complied with whelher specified herein or nol.The granling of a permil does not presume <br /> to c�ive aulhority to violate or cancel lhe provision o(any other slate or local law regulating construction or the perlormance of <br /> cunstruction.Thal I am aulhorized by lho owner o(this properfy lo perform lhe work(or which application is made and I wmply with the <br /> Slate Conlractors Law tf1.27 RCW and 296.200 WAC. <br /> ti1..��.:� !.�ICC_n <br /> Signalure oTOwnedCo raclodAuthonzed Agenl Date <br />