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�� <br /> �ERMIT APPLICA� �ON <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&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I,D.# PERMIT# <br /> oZ?o/ .���t. .�!'-cw —3 <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CIiY21P PHONE <br /> �.t��v �..a�v a7ao� �ur�r-r.QuG �u� 9�70/ f�.23-P?'i-7�79 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �,,�ed�( �/���. �as-a.s�-f`ri/�' <br /> CONTRACTO n o�. /L _.1 ' ADDRESS��pf,�"��ITYRIP PHOIN/E <br /> ��.'vfer0,�� �,df.��cQ.� ��- O¢8 � . �1s• 7a•gq��-�9�� <br /> t% 'vC.lic' <br /> CONTR.LICENSE N DEOF�Jyp O/Le�/ 9�a�3 <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��� `�� _ElecUic �,Gas_Olher �%�, "O <br /> �� <br /> WORK DESCRIPTION <br /> C���G'�....".�'' � � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR�TEM <br /> Toilet AIC—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbar/mop/etc.) _ Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trep Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I <br /> i 1 hereby ceritity that I have read and examined this application and know the same to be true and cortect. All provisions of laws and <br /> Iordinaces governing this type of work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other stale or local law reguiating wnstruction or the perfortnance of <br /> ; construction.That I am authonzed by the owner of this property to perform lhe work for which application is made and 1 comply•Hith the <br /> State Contractors Law 78.27 CW and 296.200 WAC. <br /> �a ,_...0 1as��i a-a3-cts <br /> Sig�i ature af CwnenCon crouAuthonzed Agent Date <br />