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( <br /> PE�MIT APPLICATION <br /> CITY OF EVERETT PERMIT SER�ICES <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.# PERMIT# <br /> 17t�F MA�P�C 5T2Ec m0l�D ODSo ' oS-�U <br /> LEGAL LOTNO. BLOCK TRACS , <br /> oesc. I J l i F�lO -�ll <br /> OWNER ADDRESS CITY2IP PNONE <br /> Co,v�eNa� ����y� 7�ucK�s,�� /7i� M�Pc�sT �/��r�- 98wi �`zs 30�0���. <br /> TENANTNAME CONTACTFORPERMIT //"/� PHONC <br /> l/W/<J�V <br /> CONTRACTOR ADDRESS CITV2IP PHONE <br /> OLUN�2. <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> /��S/��/1��� 5/��E ��� �„Electric X Gas_Other <br /> WORK DESCRIPTION �T <br /> �l-DD/TrD�I : /'at'"O�oM � �iN�NG ���4 � /3qTtf� �1fT�ND (���'�n1G �'crwl <br /> � 7b <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> / Toilet A/C—air handling unils <br /> / Bathlub Forced air syslems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal Gas firoplace <br /> Dishwasher Gasrange <br /> f lotheswashcr— <br /> Waler healer Range hood <br /> _ Sink (scrviceNadmop/elc.) � Exhaust tan <br /> Backllow prevenler Heat pump <br /> Urinal / � Unil heater <br /> Drinkinc� Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby cerili(y Ihat I have read and examined this applicalion and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces c�overniny lhis rype ol work will be complied with whelher specified herein or noL The granting of a permit does not presume <br /> lo give aulhority to violale or cancel the provision of any other slate or local law regulating wnstruction or the peAormance of <br /> construclion.Thal 1 am aut wiz�d by lhe owner of this property fo periorm lhe work for which application is made and I comply wilh Ihe <br /> Slale Cofilractors Law .27 CVy a� d 296.200 WAC. <br /> �i°�r�t � � i �a /� �d06 <br /> Signalure of Owner ontractor/Authonzed Agent ato / <br /> /z I <br />