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— <br /> PtRMIT APPLICATIUN <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 <br /> SITE ADDRESS PARCEL TAX I.D.# P�M—IT p <br /> �S C�� � � .2 ../t'Q /�7"�� <br /> LEGAL LOT NO. BLOCK TRACT OR SUODIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHON�yzS� <br /> �fa G�-Gr/��iy"�- �s v� /�.�l�.cr�u� Ca�r<t� I�io7� r �1y- �-J/ " <br /> TENANTNAME I GONTACTFORPERMIT PHONE <br /> E-MAIL <br /> / �'CTO/ � / AO R S � <br /> CYr/G C-v✓c 5�/.cc7 � o:h I 7,.� L. �cr!'�"ri.e Vi r.�cl d�, i=`ic+f✓� �/�f ' p <br /> CONTR.IICENSEp ��D'�`�� /��Z �J�Sz <br /> l-f�-lo �G /�SS!� � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ,� ^/ � Eleclric _Gas_Olher <br /> ��f/7_ — <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL I <br /> NO. TYPE OF FIXTUR[OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet _ NC-air handling unils <br /> Balhlub _ Forced air systems <br /> Lavalory(wash basir:) _ Gas piping <br /> Shower _ Water healer <br /> I(ilchen sink &disposal _ Gas fireplace <br /> Dishwashc� _ Gas range <br /> Cbthes w�sher _ Cblhes dryer <br /> Waten c�aler _, Ranc�e hood <br /> Sink(serviceNadmop/etc.) _ Exhaust fan <br /> Back(low prev�nler _ Heal pump <br /> Urinal _ Und heater <br /> Drinking Founlain _ Boiler <br /> Floor drein Refrigeralion <br /> Grease trap _ Woodslove <br /> Roof drains _ Other <br /> I _ Olhcr _. _- <br /> CITY OF EVERETi LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this applir.ation and I:now the same�o be Irca and correcL All provisions o(laws and <br /> ordinaces governing Ihis type o(work will be complied wilh whelher specified herein or noL The granting ot a permil does nol presume <br /> lo give authoriry to violale or cancel the provision of any olher slale or local Iaw regulating construclion or lhe performance of <br /> conslrur.tion.Thal I am aulhorized by Ihe owner o(this property to peAorm the work for whi:h application is made and 1 comply wilh lhe <br /> State Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> Signalure of OwnedContraclodAuthorized Agenl ���e <br /> I------ ------ — -- — <br />