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P�tRMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 9820'I <br /> 425-257-8810— FAX 425-257-8857—www.evereihn�a.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS ZN Fl PARCEL TAX I.D.N PERMIT X <br /> 3o�s'�t'uck« vc � _ _ ,��� c�-o�3 <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC.I <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ThcE�cvc �Y C/iNit 390/ ff��tffv{ E�r�� 9d�/ yu �/ Z <br /> TENANiNANE CON7ACTF RPERMIT PHONE �/ZS ZSY /�6 Z <br /> Tl�c Ev{a/l C/�N�C� �8►�eff Wc//�qn e.Ma� bwc//H...p �v' <br /> Z�F7�Y 'Tvi Evt.eHC/ .t- <br /> .te , <br /> CONTR.LIf.ENSE p <br /> USE OF BUIt.DING HEAT SOURCE CONTRACT PRICE OF WORK <br /> /� _Eleclric _Gas_Other <br /> WORK DESCRIPTION <br /> �qsfk//a fio o� 2 f�ct-v boi/r�s <br /> PLUMBING MECHANICAL <br /> NO. TYPE Of FIxTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handlinq units <br /> Bathtub Forced air syslems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink 8 disposal Gas(irepiace <br /> Dishwasher Gas range <br /> Cblhes washer Clothes dryer <br /> Waler healer Range hood <br /> � Sink(service/badmop/etc.) Exhausl fan <br /> Backflow preventer Heat pump <br /> Urinal Unil heater <br /> Drinkinp Founlaln � Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE 1�3105 <br /> I hereby cerilify that I have read and ezamined Ihis applicalion and know the samo to be true and correcL All provisions oi laws and <br /> ordinaces govemine�this type of work will be complied wilh wheUier specified herein or�ot.The granting of a pertnil does not presume <br /> lo c�ive authonty to violale or cancei ihe provision of any olher state or local law regulating construclion or the performance of <br /> conshuclion.That I am 3uthorized by lhe owner o(this property to pedorm the woric for which appiicalion is made and I comply with the <br /> Slale Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> �/.�///• �//.C� �Q/��/ � 7 <br /> Signature ol OwnedContraclodAuthorized Agent ate <br />