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P'�RMIT APPLICATIt�N <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 - DEBIT 8 CREDIT CARDS ARE NOT HCCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P��MIT� <br /> ���21 �-oc.�L.(=�}J.�,S'2 <br /> � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS CINIZIP PHON- <br /> 1321 co�c�y 4v,�, �arrY 4c,zcr�Dr <br /> �(�o�liO�cC MEDt CA� C�l��. �Y-12�T �161()(o L2S) 21�1-4089 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> -- t� p, STr�IE �(a.C-c�� <<4'�-S) 3�1 �-O�O-1 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING � HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> fl�S��c,v-1 pY�, �ElecMc '�Gas_Cther <br /> WORK DESCRIPTION <br /> ��•U c�-,—Z Or�f <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. 1YPE OF FIXTURE OR ITEM <br /> Toilcl A/C-air handling units <br /> Bathlub Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water hi ater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher �as range <br /> Clothes washer Clothes dryer <br /> Laundry lray Range hood <br /> Sink(service/ba!/mop/elc.) Exhausl fan <br /> Backflow preventei Heal pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodstove <br /> Roo(drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correcL All provisions o(laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or�ot.The granting of a permit does not presume <br /> Ito c�ive aulhonty to violate or capcel the provision o(any other slate or local law regulating construcUon or the performance of I <br /> construction. Th t I am authori�ed by the owner of lhis property to per(orm the work for which application is made and I comply��vilh the I <br /> State Co Law 18.27 R�W and 296.200 WAC. <br /> I, ,� �� � oS � <br /> ! SignaW e of Owner/ uthonze Agent Date � SQ�o " � <br /> i I <br />