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P�r2MIT APPLICA�IO�I <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 ACCE.PTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS � I PARCEL TAX I.D, # PERMIT# <br /> �117 IZpINIEiZ C i� ooa�ZQ�on �o� CYx� 6D3 � D�'.' <br /> LEGAL LOT NO. BLOC—K7 TRACT <br /> DESC. ( Q / B2U2Y'�� '"II�IS �1�: I �47�� 754^ —��12. <br /> OWNER ADDRESS CITY/ZIP PHO E <br /> S�TEV� La4N�sv�P,)c 43is 5-r,?��rL�t ��a� �N,el( wa 98oiz <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# � <br /> �7�vr_s��s skl� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> j r 1L Eleclnc �Gas Olher � <br /> ' WORK DESCRIPTION <br /> ,�✓�� �i�����1.�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �� Toilet A/C—air handling units <br /> � Bathtub Forced air systems <br /> Lavatory Qvash basin) �. Gas piping <br /> � Sho::cr �_ Water heater <br /> � Kitchen sink 8 disposal _� Gas fireplace `�ian���/ <br /> � Dishwasher Gas range � I � ��' <br /> v Clolhes washer _� Clothes dryer i !F 1� <br /> _ Laundry t2y � Range hood �� <br /> _ Sink (servicelbar/mop/etc.) �_ Exhaust fan <br /> _ Backflo�v preventer j � Hoat pump � <br /> Unnal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refngeration <br /> Grease;rap l��oodstove <br /> Roo(drains Olher <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined lhis applicalion and know the same to be true and correct. AI' provisions of laws and <br /> ordinaces governing this rype oi�vork will be complied with�vhether specified herein or not. The grenting of a permit does not presume <br /> to give authoriry to violate or cancel tho provision of any other state or local law regulating constructlon or the performance of <br /> i construction.That I am authoriz�d by Ihe owner of this property to perform the wotl<(or which application is made and I comply with the <br /> � State Contractpis Law 1�W and 296.200 WAC. <br /> � ) <br /> �� �. <br /> . .� �" � , , ^ l <br /> SignaN of nenContractorlAuthonzed Agent Date l <br /> � <br />