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C - � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-BE57-www•evereriwa.org <br /> APPLICATIONS AR[ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS Pnf2CEL TAX I.D.# � R�Ij�I O — �� / <br /> Z / /�v OOS171 SS`I a o60c'� `� � <br /> LEGAL LOTNO. BLOCK TRAC� <br /> DESC. <br /> ONMER ADDIiL�S CITYIZIP PHONE <br /> GG�C'+�'r To<"TI � I � 7/J i l(/G�7�r � �`�� 7oQi� ZOEa'�10�3���� <br /> 7ENANTNAME CONi�CTFORP[RMIT PHONE <br /> IC�c� 'f�7-S$8l^ zz <br /> CONTRACTOR AUUi:C'S CITYIZIP PHONE i/Zj <br /> /►7ihc.cw.,�'+�� sy�..-o �,�, �tr�o,3 �v� EaB�'tisf- f�cvz-,o..A $?r/� 7'9�mo <br /> CONTR.LICENSER ��=y��� G� <br /> I�J/YlGO/�7 �`�J <br /> USE OF BUILDING I — �itnT SOURCE CONTRACT PRICE OF WORK <br /> 0 <br /> Eleclric ,�Gas_O�her p?�j��Z � <br /> WORKDESCRIPTION /dc���c� O/G. .CZe.%�— /.��/<<a � �� Ba.L4,. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C—eirhandlingunits <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) � Gas piping <br /> Shower Waler healer <br /> Kitchen sink&disposal ! Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer � Clolhes dryer <br /> Laundrytray _ Rangehood <br /> Sink(servicelbarlmop/etc.) _ Exhaust fan <br /> BackOow preventer _ lieal pump <br /> Urinal Unit heater <br /> Orinking Fountain � Doiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Olher — <br /> CITY OF EVEHETT LOCAL SALES TAX CODE IS 3106 <br /> I hereby ceritiy that I have read and examined this application and know the same to be true and cortect. All proviafons of laws end <br /> ordinaces goveming this lype of work will be complied with whether specified herein or not.The granting of a pertnit dces nol presume <br /> to give authority to viola[e or cancel the provision of any other state or local law regulating conshuction or lhe performance of <br /> conslruction.That 1 am authorized by the owner of this property to perform the worl�for which application is made and I comply with the <br /> State C Iractors L�RCW and 296.200 WAC. <br /> � y—.�y/ <br /> '�gnature of O er ntractorlAuthonzed Agen[ Date <br /> �S a � �f 9 �0 7 <br />