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1 <br /> _ _� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425 157-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.p PER,�IIT# <br /> 2o I �' cl�.e.�e,l l� e� �3 2 Z o UD 5�� -� <br /> L[GAL LOTNO. B�OCK TRAC7��� v� rVQ.Y'UI ✓�V \\L�', <br /> DESC. !�G � j <br /> OWNER ADDRESS CITV2IP PHONE ZS ZSZ_2G•Z <br /> �h2+'r� F�is�nmu,� 2018 ���el le✓ AJ� �ve,�e�C �8za I ��w <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �IA Gl�r✓� �;senmG.� 4zs�=o�x ��k_ � <br /> CONTRACTOR A�DRESS CIN21P PHONE I <br /> \ <br /> CONTR.LICENSE 7t j�/� �� � ��� i <br /> �' �� � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��j� � _Eleclnc _Gas_Other //�J��- <br /> WORK DESC ION <br /> l� {,�( �C�C-��' �el'!�I J✓ <br /> � / _�_ I�CJ <br /> PLUMBING MECHANICAL <br /> NO. IYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> _ Toilet � FVC—air handling units I <br /> 8alhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal `_Y Gas freplace <br /> Dishwasher ` Gas range <br /> Cbthes washer _ �G othes dryer <br /> Laundry traY Ra e hood <br /> I _ Sink(s'ervicelbadmop/elc.) _ Ezhailslfan <br /> _ Backflowp�venter _ Heatpum <br /> Urinal � Unit hca�er <br /> Drinking Fount�ec� _ Boiler <br /> Floordrain �� Refrigeration <br /> Grease lrap Woodstove <br /> Roof drains �� _ Other <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 Ihe same to 6e lrue and correct. A!I provisions of laws and <br /> ordinaces goveming lhis type of work will be complied wilh whelher specified herein or nol The granGng of a pertnit does not presume <br /> , to grve3uthority lo violale or cancel lhe provision of any other state or::cal law regulating construc6on or the periormance of <br /> . rans�ruction. That I am authorized by the owner of this propeAy to pedorm the work for which applicaGon is made and I comply with�he <br /> Stal�CoNractors aw 27 R6W and 296200 WAC. <br /> �1 �--� �l�`'I t'S ' <br /> S 9n�tur o( nedCo rac or Authonzed Agent Dale � <br /> --- --- �2- I <br />