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PEKMIT APPLICATIOIv <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRErT, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www•everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> pARCEL TAX I.D.q I PEi),M T MDr 2 9� <br /> SITEADDRESS I , � �/� <br /> 1-> I 1 1':��c!«� �+�vc, i i ,� �a-�dU (�U�300 <br /> � � <br /> LEGAL LUTNO. BIOCK TRA1CTy ,.ry"�� T R <br /> [IESC Lj '� I D ��"��'� �`Cll b���L"" V1VILI 1�CITY2IP PHONE <br /> � OWNER ADDRESS <br /> , I �(��; 5`I�����1�1`i <br /> I,�ISi,� N�''CI�, � I��iI�I I�l1f.Kf i -{'l-t', � �t �t' t.11l 1� PHONE <br /> TENANT NAME I CONTACT FOR PERMIT <br /> 1� <br /> �.I=�F (YI r�C f�.� <br /> CONTRACT R ADORESS CITY2IP PHONE <br /> , � <br /> � S / <br /> ONTR. ICENSEi{ �� / / �.,��� <br /> ` l_G�I / <br /> USE OF BUILDING HEAT SOURCE �CONTRACT PRICE OF WORK <br /> �q,y��Q� _Eler.lric _Gas,_Othcr �T'�°v• CU <br /> WORK DESCRIPTION ��/0� <br /> l�ti��l�d �n,� r��t�n�jt. r <br /> j/SSt <br /> PLUMBING MECHANICAL <br /> NO. <br /> TYPE 6F FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> A/C–air handling units <br /> Toilet Forced air systems <br /> Bathtub Gas piping <br /> Lavatory(wash basin) — Water heater <br /> _ Shower Gas fireplace <br /> Kitchen sink&disposal — Gas range <br /> Dishwasher Cbthes dryar <br /> _ Clolhes washer Range hood <br /> Waler heater Exhausl tan <br /> _ Sink(service/badmopletcJ — Heat pump <br /> Back(low preventer Unit healer <br /> Urinal goiler <br /> _ Urinking Fountain Refrigeration <br /> _ Floordrain Woodslove <br /> Grease trap Other <br /> Rool drains — <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify lhat I have read and examined this application and know the same to be lruo and correcl. Ali provisions of laws and <br /> ordinaces goveming lhis lype of work will be complied with whether specified herein or noL The grenting of a permil does not presume <br /> to give aulhorily lo violate or cancel lhe provision of any other state or local law regulaGng consWction or the peAormance of <br /> conslruction.That I am authorized by lhe owner of this property to per(orm lhe work for which applicatioa is made and I compty with lhe <br /> Stale Contrac i rs Law 18.27 RCW and 296.200 WAC. <br /> �4P�e �� a�'�' �°� <br /> � Date L/v <br /> Signalure of vnedContraclodAuthonzed Agent � <br />