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F�cRMIT APPLICATIUN <br /> CfTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810 — FAX 425-25'i-8857—w�nnv.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ,� 3 iT �.- ` e � -ri lZ'� <br /> LEGAL LO 0. BLOCK TRACT <br /> DESC. � �'; � rcl� �io,-i� f' �`r:i'v- '�l�'z—/L —p� <br /> OWNER DRESS CITV2IP PHONE <br /> ��aL /'lt�/��ti.�T _(,,,,� (�ylU ����.t � �' /UL G`fn"�4tF�3G yLr ��1� 9rrY <br /> TENAN7 NpM� CUNTACT FOR PERMI7 PHOnL' <br /> • . . . • , I ��� % ,�;tit�z �Lr v�.� 9T�r. , . <br /> , , <br /> CONTRACTOR � R ��„��e�'���ir� S.,c ADDRESS CITY2IP PHONE <br /> • � . il,�.ar�,a� �*�� y�,, � ��.r.7,�r 9my <br /> CONTR.LICENSE71 . ,, : •.. .�,� � ¢ , :, ,L ����� <br /> PI�LEniL�o:�6�� �oz 9�3� — <br /> USE OF BUILDING NEAT SOURCE CONTRACT PRICE OF WORK <br /> 5��. _Eleclric �Gas_Olher <br /> WORK DESCRIPTION <br /> Co„ r�.-�c��- new sf-�l"' r�irr� � <br /> /d'� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _� Toilet rVC—air handling units <br /> _� Balhlub _L Forced air sys�ems <br /> � Lavalory(wash basin) _� Gas piping <br /> Shower � Water healer <br /> � Kilchen sink&disposal / Gas fireplace <br /> � Dishwasher � Gas range <br /> _� Cblhes washer � Clothes dryer <br /> � Water healcr � Range hood <br /> Sink(servicelbarfmop/etc.) � Exhaust fan <br /> 6ackflow prevenlcr _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Re(rigeration <br /> Grease trap _ Woodstove <br /> Root drains Olher _ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y that 1 have read and examined this applidation and know the same to be true and rorrect. All provisions of laws and <br /> ordinaces governing this lype of werk will be complied with�vhelher specifed herein or not.The grenting of a permit does not presume <br /> to give authonty to viulate or cancel;he provision of any other state ur local law regulating conslruclion or the performance of <br /> consWclion.Thal I am authorized by lhe owner ot lhis property to perlorm lhe work for which application is made and I wmply with the <br /> Sla onlractor 18.27 RCW nA 296.200 WAC. <br /> ��� % /l�/6�03 <br /> SignaWre f Ownerl ontractor Authonzed Agent � � Date � I <br /> �-- - - ! <br />