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PLRMIT 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 � �a,O s <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMI7# <br /> `'(3i. 3 �51n«-r�� �r. tu�. M :�-..��_ <br /> LEGA LOTNO. ALOCK TRACT <br /> DESC. <br /> OWNER ADURESS CIlY21P PHONE <br /> LCav� AR� C�rtN ��303 5��ro�, �-, ���,`rcFi� �tk��l �irJ�Fs7o-66S�i <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � '�-btvt����tvl L(.��Ff7o'6(�S �l <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF UUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Olher <br /> WORK DESCRIPTION <br /> �/ ' li�// /Cc.�L� <br /> ���� �� <br /> . PLUMBING MECHANICAL <br /> N0. TYPE OF FIl(TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling units <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) � Gas piping <br /> _ Shower �, Waterheater <br /> Kitchen sink 8 disposal Gas flreplace <br /> _ Dishwasher _� Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbar/mop/etc.) Exhsust fan <br /> Backtlow prevenler Heat pump <br /> Unnal Unitheater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> � <br /> , CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> �' I hereby ceritify that I have read and examined this application and know lhe same to be true and correct. All pn.visions of laws and <br /> � ordinaces governing this type of work will be complied with whether specified herein or not.The grenting of a permit does not presume <br /> I to give authonty to violate or cancel the provision of any other state or local law regulating construction or the pe�formance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> i Slate Conlractor�Law 18.27 RC �a d 296.200 WAC. <br /> i <br /> � /�";�,�z<� C� � �- �r�oS <br /> '(Signat e of OwnerlContractor/Authonzed Agent Date <br /> I <br />