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- -- t — -- — <br /> �'ERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—v�nvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �.�9 —/� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> y q�/ G�e.s cr' ,��^ ' I OUB-fX� <br /> L6GA LOT NO. BLOCK TRACT OR SUODIVISION# <br /> �ESC. <br /> OWNER A�DRESS CITYIZIP PHONE yZs- <br /> � cir c_'J�Lric,h�+'� y96/ l��'.Si�c'rQ�. �v��c-'tt�d8zo.3 zvs-g76Z <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> NTRACTOR ADD S CIT I PH E <br /> CONTR.LICENSE# Q�t�/l(E/Q <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> S j pC��C; '/'A h"1/�L� _Eledric _Gas_Other <br /> WORK DESCRIPTION <br /> j/Y^/�q`J��Gn— �UCk��E,e.,.� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR IT[M NO. TYPE OF FIXTURE OR ITEM <br /> 1'oilet A/C-air handling unils <br /> Dathlub Forced air syslems <br /> Lavatory(wash basin) _ Gas pipiny <br /> Shower _ Waler healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Uishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water h�aler Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> dackflow prevenler _ Heat pump <br /> Urinal Unil heater <br /> Drinking Pountain Boiler <br /> Floor drain Refrigeration <br /> Grcase trap _ Woodslove <br /> Rwf drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> � hereby certify Ihal I have read and examined ihis applicalion and know lhe same lo be true and correct. All provisions of laws and <br /> ordinances goveming this type o(work will be complied wilh whelher specified herein or not. The graniing o(a permit does not presume <br /> to give authority lo vidate or cancel Ihe provision of any other slate or local law regulating construction or ihe pertormance of <br />� construclion. That I am aulhorized by lhe owner of this property lo periorm Ih�work for�t�hich application is made and I comply wi�h�he <br /> Sla�e Coniradors Law 18.27 RCW and 296200 W�1C. <br /> � . � <br /> �� - � �.c��J _�'_�_- 9'iG' -- <br /> � nalure o(Owned ifa or/A� orized Agent Date <br />