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P�r2MIT APPLICATIC�rJ <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& CREOIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 7�i7 iZpiNiE� �G � oos�zsoo�o� mo � Sb3 � �i; <br /> LEGAL LOTNO. BLOCK TRACT <br /> �esc. ( � Beuerly �-�i��S D�J: � (4zS� 7S4- -7_Ol2 <br /> OWNER ADDRESS CITY2IP PHO E <br /> STEvt L_,4NDsvkRk d3iS ST12.lIlMW1t '���4� �f��el( c,.�A Ypoiz <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR AOORESS CITY2IP PHONE <br /> CONTR.LICENSE il � <br /> .�-f E V�SLQ SS I< IC <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> '� �� Electric �Gas Other I I <br /> WORK�ESCRIPTION <br /> Ne �:� �J����_�[�c�c <br /> PLUMBID;G MECHANICAL <br /> NO. TYPE OF FIXTURE OP ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel A/C—air handling units <br /> Bathtub Forced air systems <br /> . Lavatory(wash basin) l,; Gas piping <br /> _,� Shower �� Walerheater L�, ��� <br /> � Kilchen sink 8 disposal _,� Gas fireplace ��(10.� � <br /> � Dishwasher Gas range <br /> � Ciothes washer Cbthes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> _ Backflow preventer :% Heat �m <br /> P' P � <br /> Unnal Unit heater � <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3'105 <br /> I hereby ceritify that I have read and examined this apptication and know the same to be lrue and correct. AII provisions of laws and <br /> ordinaces governing this type o(work will be complied with whether specified herein or noL The granting of a permit does not presume <br /> to give autho�iry to violate or cancel the provision of any olher state or local law regulating construcfion or the peAormance of <br /> consWcti�n.That I am aulhonzed by the owner o(this property to perform the work for which applicalion is made and I wmply with the <br /> Slate Contractors Law 18.27 R N and 296.200 WAC. <br /> '� <br /> � , ��� . ✓�',. �� <br /> Signamre f �v�iContrector/Authonzed Agent ` Date <br /> � �L <br />