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PtRMIT APPLICATIUN <br /> CITY OF EVERETT PERMI'f SEIRVICES <br /> 3200 CEDAR STREET, EVERFTT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.eve rettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM'f0 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.if PERMI N <br /> I D.�l �t �ir1c4� Q-llfi oo�/�o b�al l�v�ov _ ' /Z/ <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION A <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �, '.� �l z�-_339-9�'.�S <br /> /,ti � ,clrr.11� <br /> TEN NAME V I CONTACTFORPERMIT PHONE <br /> E•MAIL <br /> N ¢a� r��� �����,�.� �. ��� �yn,,,,.,�o��►� �l?s�-�6� <br /> r <br /> CONTR.LICENSE� �-�C cF G rrt ��� �-7� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � � � / Electric�Gas_Other y/�Q � <br /> . ��G�.��. �C z., `_ �` ' <br /> WORK DESCRIPTION , . �j( �.fi�j�bL�/tw`^� <br /> J�2� �o.y.�-�,y -�Kr�K d���t ,�-�, <br /> PLl1MBING MECHANICAL <br /> Np, TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C—air handling unils <br /> 6athtub Forced air systems <br /> Lavalory(wash basin) J_ Gas piping <br /> Shower _ Waler heater <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clolhes w.sher _ Cl�thes dryer <br /> Water heater _ Rango hood <br /> Sink(serviceNadmop/elc.) _ Exhaust tan <br /> Backllow preventer _ Heal pump <br /> Urinal _ Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain _ Refrigera�ion <br /> Greaso Irap _ Woodslove <br /> Roof drains __ Olher_ <br /> = Other I _ _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify lhat I have read and examined lhis application and know lhe same lo be lrue and coRect. AII provision�ot laws and <br /> ordinaces 9oveming this lype of work will be complied with whethei specified here�.n or nol.The graNing of a permil does not presume <br /> to c�ive.authorily lo violate or cancel the provision of any other state or local law reyu��ting construction or the perfomiance of <br /> consiruclion. That I am,aulhorized by the owner of this property lo pedorm the work tor which application is made and I comply wilh the <br /> Stale Conlractors Law i RC nd 296200 WAC. <br /> l, �� ���"�f��- f , �� <br /> l.Signat re ot nedContracbdAu�honz�d Agenl Date <br />