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`r ERMIT APPLICATi.,1N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRECT, EVERETT, WA 98201 <br /> 425•257-8810- FAX 425-257-8857-www.everettwa.org <br /> ,� '`l �� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERM1IIT;i <br /> 'S`3`t�Z 3r� �vC SC C�C�39:� -cvc� •-O! -UG I C� ,I`'%.� " �-��1 <br /> �_2GAL LOT NO. �LOCK TRACT <br /> �_S� r u,r,�f ,3 o C�� G,����c �o���� <br /> 01'lt:ER A�DRESS C /ZIP PHONE <br /> �r�l'c;'�`cl ��1G:�c'i /.r�f,,�v,�, 6z/sRY •vE�i9lb� C-Y L/� S/cua�s �3'2��� -- <br /> 7ENANT NlJAE CONTACT FOR PERMIT PHONE <br /> � --�- Fr�:,�1 G o•�L �/,��= yZ �-��-�/ <br /> COt7TRAGTOR �"'�� . ADDRESS � � CITY/ZIP,� • PHONE �- ' ' 'i <br /> � �rrJie:�f�k G/,u,^/r s �o�,rtr�, G2/ S�S niE Pr�rii c y �/< stc✓u�r <br /> CONTR.LICENSE p • '� :j '� , .� � j•• ;. ' <br /> `i��DG CL(JS J OQ _ <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PRICE OF WORK I <br /> S'�� ,�,Electric _Gas_Other ��(J���G��� _— � <br /> � \VORK DESCRIPTION' <br /> � � � (.,��7- (_, � ��;�,:���-: ?� � <br /> PLUMBING MECHANICAL <br /> t10. TYPE OF FIXTURE OR ITEh1 N0. TYPE OF FiXTt1RE OF ITER1 � <br /> I <br /> � 3 Toilet A/C—air handlinc� u�ils I <br /> ,2 Bathtub Forcod air systems �� <br /> ' _3_ Lavatory(wash hasin) I Gas piping i <br /> Shower �— �Vater hoaler �� <br /> � Kitchen sink&disposal � Gas lireplace <br /> i Dishwashcr Gas ranpe <br /> , _� Clathes washer _,(_ Clolhes dryer � <br /> 11'ator haater _� Range haod <br /> , Sink(service/badmo��'etc.) _,� Exhaust fan <br /> Backflow preventer Heat pump <br /> Uiinal Unit hcater <br /> Drinking FounlOin Boilet <br /> Floor drein Rotrigeration <br /> Grease trap Woodstove <br /> T Roof drains �' _ Olher�_ <br /> i Other , <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 � <br /> I nereby ceriti(y that I havo read and oxaminod lhis application and know lho samo to bo true and corroeL All provisions of laws and <br /> ordinaces governing lhis typo of work�vill bo complied with wholhor speci(ied herein or noL Tho granling of a permit does not presume <br /> iu give authority to violato or cancel the provision o(any other state or Iocal law regulating construction or tho peAormanco of <br /> wnstruction.That I am authorized by tho cwner o(lhis property lo pedorm tho work for which applicotion is made and I comply vrith tlr_ , <br /> State Contractors Law iB.27 RCW and 296.200 WAC. <br /> Sgnature of OwnedContraclodAuthonzed Agent Date <br /> �I� <br />