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PtRMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, GVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PAR:;EL TAX I.D.# PERMIT# <br /> 5�� 7 Vl� l� D�;Cy- bo� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE �` � i/Z <br /> KL� NE�J��u �� � Pc� ��x lo �� �v�r�n- w�- s���o - <br /> TENANT NAME CONTACT FOR PERMIT PHONE [�L j �� D—�Q r� <br /> N/� �l� ��l�T�J i ��C�I` C•MAIL <br /> CONTR T R ���= ADDRE S � 0 <br /> CONTR.LICENSE N <br /> USE OF DUILDING I1EA1'SOURCE CONTRACT PRICE OF WJRK <br /> � 4 � �/I' [ledric Gas Olher <br /> WORK DESCRIPTION <br /> /�� M�' l-�o,�se �� T7Z���rL�2t; <br /> PLUMBING MECHANICAL <br /> NO. iYPE OF FIXTURE OR�TEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC-air handling unils <br /> Balhlub Forccd a�r systems <br /> Lavalory(wash basin) Gas piping <br /> Shower W aler heater <br /> Kitchen sink&disposal Gas lireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> Waten c�atcr Range hood <br /> Sink(servicelbadmop/e�a) Exhausl fan <br /> Backllorv preventer Heal pump <br /> Urin,I Unil healer <br /> Drinkiny Founlain Boiler <br /> Floor drain Re(rigeralion <br /> Grease trap Woodslove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3f05 <br /> i <br /> iI hereby cerilify�hat I have read and examined Ihis applicalion and know Ihe same lo be lruo and correcl. All provisions ol laws and <br /> ordinaces yoveming this type o(work will be complied wilh whelher speci(ied herein or noL The granting of a permil does nol presume <br /> Ito give aulhority lo violale or cancel lhe provision of any other slalo or local law regulating consiruclion or Ihe pedormance of <br /> conslruclion.�hal I am aulhorized by the owner of lhis pwperty to perionn ihe work tor which applicalion is made and I comply with Ihe <br /> iStale Contraclors Law 18.27 RCW and 296.200 WAC. <br /> � J��������, y �� � <br /> SignaWr ol OwnedCon rac�odAulhorized Agent ' ate <br />