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P�.RMIT APPLICATI(�N <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 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS _R `�� PARCEL TAX I.D.# PKRDMIT��_D�� <br /> � �-{ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> 1= �/ � � �I�l Sc.�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE �� <br /> q''�� � t�l�c,�.� �--S�-+Z/��--`il i,l�'—'�1Of "(� <br /> CONTRACTOR L�/,ti ��RA.�-in� ORE55 CITY2IP PHONE <br /> • -7 <br /> CONTR.LICENSE# <br /> L.W�K��.T.'� D°15 Q-�� <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> ElecMc �Gas Other 5 Q� �� <br /> WORK DESCRIPTION _ <br /> QLu�^ Cjn,� L.v��t� <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI7(TURE OR ITEM <br /> _ Toilet A/C—airhandlingunits <br /> _ Bathtub Forced air systems <br /> Lavatory(wash basin) T Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal � Gas flreplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> BackOow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain � Refrigeretion <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> i — _ <br /> ICITY OF EVERETT LOCAL SALES TAX CODE IS]105 � <br /> I I hereby ceritify that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether;pecified herein or not.The granting of a permit does not presume <br /> I to give authonry to violate or cancel the provision of any other state or local law regulating construction or the performance ot <br /> I c�-<truction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> Contractors Law 18.27 RCW and 296.200 WAC. <br /> j �r-�tib..c� � ^ �a-�4�( <br /> ISi ature of Ownen ont�on�nzed A� Date <br />