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PtRMIT APPLICATIGN <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 a -O(� �pq <br /> SITE AD�RESS PARCEL TAX I.D.# PE��� <br /> � � ' � /Ll�t �/� Sf , - _ /- - �� l � � �-- / <br /> IEGAL LOT NO. BLOCK TRACT OR SUBGIVISION# <br /> DESC. <br /> OWNER /I I ADDRESS CITY21P9���PHONE '— �-7_ <br /> EIIZ.Ct�t� l-� �� f�C��l 9!� o2C:�q ��P�� 57�� �CJe l-i - 9</03 <br /> TENANT NAME CONTAC7 FOR PERMIT PH NE � <br /> (Cl C.,���-��') l(��'V L, E-MAIL <br /> CONTRACTOR '1�//^��n ADDRE S ITY/ZIP H NE <br /> CJ / <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> `�Eleclric Gas Olher <br /> WORK DESCRIPTION � � <br /> ��� �� , �.. ���:� k ��L �J�-�,- � ��� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A!C—air handling unils <br /> Balhlub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Wafer heater <br /> Kitchen sink&disposal _ Gas(ireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mop/elc.) _ Ezhaust lan <br /> Backllow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeralion <br /> Grease trap _ Woodslove <br /> Roof drains _ Olhcr _ <br /> � Other C�' �c: — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y thal I have read and examined this application and k�ow the same to be true and correct. All provisions of la�vs and <br /> ordinaces governing this type of work will be complied with whether specified herein or noL The granting o(a permil does not presume <br /> lo give aulhor,ty to viNale or canr.el lhe pr'vi ion of any olher tale or local law regulating construction or Ihe performance o( <br /> construction.That I am authorized by th o� er of this prop y lo perlorm Ihe work for whic!i appticalion is made and I comply with the <br /> Slate Conlraclors,Law 18.27 R an 2 .200 WAC. <br /> :� l , , ,(GZ.t ° � ,� � - �y <br /> �naNre OwnedContrectqr/A t iorized Agent Date <br /> � � —� — \ <br />