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I�CRMIT APPLICATIVN <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 ( a �6 ��S <br /> SITE ADDRESS ��`�"f PARCEL TAX I.D.# PERMIT#� <br /> � oZS' S1iar� ve /�.�'/Z :.� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER - ADORESS CITY2IP PMONE <br /> J c-�' �'sz��` 352�' Sl,�� quc ���-c�{ I`�''.,�a�' o� �� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> SPeSocIL �e'�-� �D�^�� ���/ �i�1� <br /> CONTRA TOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE 71 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Electric �Gas_Olhcr <br /> WORKDESCRIP7tON N�W ��✓c- S�rd)'Ge <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toile� A/C-air handling units <br /> Bathtub Forced air systems <br /> _ Lavatory(wash basin) � Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Cbthes dryer <br /> Water healer Range Mod <br /> Sink(service/bsi/mop/etc.) _ Exhaust fan <br /> DackOow preventer Hea�pump <br /> Urinal Unil heater <br /> Drinkiny Fountain Boilr.r <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstovc <br /> Roof drains Other <br /> Other <br /> CIN OF EVERETT LOCAL SALES TAX COOE IS 3705 <br /> I hereby ceritity Ihat I have rcad and examined this application and know the same to be tru�and corcecl. All provisions of laws and <br /> ordinaces�oveming lhis lype of work will be complied with whelher specified herein or not.The granting ol a pormil does nol presume <br /> to give authonty lo violale or cancel lhe provision of any other slate or local law regulating consWction or the pedormance o( <br /> construction.Thal I am aulhorized by Ihe owner of lhis propeAy lo periorm the work for which application is made and I comply wilh the <br /> Slale Conlrectors Law 1827 RCW and 29G.200 WAC. <br /> � � <br /> %�/ ���/ �� ��r <br /> Si�atut . wner/6,ntr b odAuthorized Agent Date <br /> l / � <br />