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PEhtMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982C1 / <br /> 425-257-8810- FAX 425-257-8857 -ww�v.everettwa.org ol '-�g�b <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ���.: (y a� � � � <br /> SITE ADDRESS � /,G PARCEL TAX I.D.# P/�RMIT# <br /> �7 . ' lv[• L � Vl, l� �� �� - � � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER A�DRESS CITYIZIP PHONt <br /> .��5��«r� L[ c <br /> TENANT NAME CONTACT FOR PERMIT PHON •lz�� _ �' <br /> � yzs'- 7S�'' <br /> ./��3� �.� s G��� �f�.,� ,r� L,�s�Ss� _yzs 3/7- 1��f�Z - O <br /> CONTRACTOR ADORESS CITY2IP PHONE <br /> ��;�ss< <<-�,5���s.��fr� yai= ;/7-yd'y2 <br /> CONTR.LICENSE N <br /> 3 z�7 G,1.-►.�..� f-vt�lC�f- 9f zo� <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF YlORK <br /> �eciric Gas Other <br /> �i'1lf�l' - tlJtl L-Yi�J/�LYSA — — <br /> WORK DESCRIPTION � <br /> ��b � ��l/L'— J�lL/t i 1 � it .� ! / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIxTURE OR ITEM <br /> Toilel _ NC-air handling unils <br /> Balhlub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> Water healer Range hood <br /> Sink(scrvicc/bar/mop/utc.) _ Exhausl fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit healer <br /> � = Drinking Founlain = Boiler <br /> Floor drain Re(rigeralion <br /> Grease Irap Woodstove <br /> Roof drains Other <br /> Other <br /> ( � <br /> CITY OF C-VERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and ezamined lhis applicatlon and kno�v the same to be irue and correcL All provisions of laws and <br /> ordinaces c�overning lhis type uf work will be complied a+ilh whether specified herein or noL The�ranling of a permit does not presume <br /> to give authoriry to violate or cancel the prov;sior of any other slate or local law regulaling construclion or the performance of <br /> constmction.That I am authorized by lhe owne� o(this property lo pertorm the work for which application is made and I comply with Ihe <br /> State Contraclors Law 1827 RCW and 296.200 WAC. <br /> Signalure ot OwnedContractodAuthorized Agent Da�e �IL <br />