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FtRMIT 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 1� `�$-p S <br /> SITE ADDRESS PARCEL TAl(I.D.# PERMIT�// �� <br /> ✓IA <br /> ��'�1-7 �e��'lU\S1 U� . /YI <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> (�� qrzr5 <br /> �_���+�j� Yl�� av�e � O�.rv� �� -`��X IS � i •\U���r�'G � �S ' �3P. �Y`�`�9 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR C IYI 1�C n�-�� r.� ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# J Q E i-C� <br /> M�, GA'i '� o9� 1�. -� 1�1ia R��a�w �v `�veYe}� �{�s �54 - i��bl� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> `.��,�� __Eleclric �Gas_Olher <br /> WORK DESCRIPTION <br /> � <br /> 1_rs1 .r1� c- a�. ��.`�nace', 5��.1� er {'���r�, ��F��i .nces <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTI IRE OR ITEM NO. IYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Dathtub � Forced air syslems <br /> _ Lavatory(wash basin) � Gas piping <br /> Shower Waler heater <br /> Kilchen sink 8 disposal Gas tireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> 1Naler heater Range hood <br /> Sink(service/badmop/elc.) Ezhaust fan <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeration <br /> Grease;rap Woodstove <br /> Roof dreins Other <br /> Other <br /> CITY OF EVEHETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify ihat I have read and examined ihis application and know�he same tu be We and correcL All provisions of Iaws and <br /> ordinaccs governing ihis lype of work will be complied with whether specilied herein or not.The granting of a permit does not presume <br /> lo give autnority to violale or cancel ihe provision of nny olher stale or local law regulaling construction or lhe performance of <br /> conslruction.Thal I am au�horized by the owner o(this property to perform the work for which application is made and I comply wilh lhe <br /> State Conlraclors Law 18.27 RCW and 296200 WAC. <br /> (�-- '�vzr� 1._l ce,., 11 • � �'O s <br /> SignaWre ol Owner/ContractorlAu onzed Agenl Date <br />