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i <br /> PERMIT APPLICATI(�N <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,k I p���1'� <br /> ZZZ� l,�ef.��or� ,C�/ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITY2IP PHONE <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR �—K �Jor�S ADDRESSSjZ S L K /�otfi �CnITY21 Zssz��� <br /> � ��-n�,��wr�HONE Lp�, <br /> CONTR.LICENSEN 'T�CUO�IitJ� ��3 K� `� 90Z5d <br /> USE OF BUILDING HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> 2�L ��'�- - � - �jC�OD "- <br /> Electric Gas Other <br /> WORKDESCRIPTION C-�QS 1 � -� F�cu, �,y�o-t'�-� �{-o v.�yt <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> _ Toilot A/C-air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) 7-. Gas i in <br /> Shower — P P 9 <br /> — Water heater <br /> _ Kilchen sink 8 disposal Gas fireplace <br /> _ Dishwashor Gasrange <br /> _ Clothes washer Clothes dryer <br /> _ Waler heator Range hood <br /> _ Sink(servico/bar/mop/etc.) Exhausl fan <br /> _ Dackflow preventer Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> Olher — — <br /> CITY OF EVERETT LOC4L SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this appiication and know the same to be true and correct. Atl provisions of laws and <br /> ordinaces governing Ihis lype o(won:will be complied wilh whelher spocified herein or noL The granting of a permic does nol presume <br /> to give authority to violale or cancel the provision of any other state or local Iaw regulating construction or the per:ortnance of <br /> conslr ction.T I am authorized by the owner of this property to perform the work for which application is ma�'e and I compty wilh the <br /> S te onlra ors L w 1827 RCW and 29G..00 WAC. <br /> ) �c-..�� l I 0 � <br /> SignaWr o vner/Conlractor/Authorized Agent ate <br />