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PcRMIT APPLICATION <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 ADDRES:i PARCEL TA7C I.D.M PERNIT/ <br /> 3�'23 Sr+a�� �N�Ju� G�y33 ��x�2�o��. r���0� ��� <br /> � <br /> LEGA LOTNO. BLOCK TRACT — <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��+� �=�-��� �,L3 ` � .�� Cy��3y�-�Z►Z <br /> TENANT NAME CONTACT FOR PERMIT t'HONE <br /> �N.J ���-���5s� �ofrnJ �D�^��u ss� �� 3`15 - �i Z-U 2 <br /> y1� z5'} • 03'��, <br /> CONTRACTOR U�,J�.�_ ADDRESS CITY2IP � PHONE <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �C 3 ��Et�1'r I�Z— _Electric �Gas_Other ( <br /> WORK DESCRIPTION <br /> {�,�,,N� ��,.��� �` —� �.��3�� �F-�3,r��� <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ' Toi�et A/C—air handling unils <br /> '� Bathtub � Forced air sy�lems <br /> '� Lavatory(wash basin) _ Gas piping <br /> � Shower � __ Water healer <br /> Kilchen sirik 8 disposa� Gas fireplace <br /> � Dishwasher Gas range <br /> Clolhas washor Clothes dryor <br /> Waler healor Range hood <br /> � � Sink(service/badmopletc.) Exhaust fan <br /> BackOow preventer Heat pump <br /> Uiinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Reirigeration <br /> Grease lrap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerilily that I have read and examined this application and know Ihe same to be true and correc�. All provisinns oi laws and <br /> ordinaces governing this type ol work will be comp�ied wilh whether specified herein or not.The granting of a permit does not presume <br /> to givo authority to violate or cancel tho provision of any other state or local law regulating construclion or the peAurmance cf <br /> conslruction.Thal I am authorized by the owner of this property to per(orm the work for which applicalion is made and I compiy N�ith the <br /> State nlrac/torsl�w 18.27 RCW and 29G.200 WAC. <br /> ,=' � d�^�.(�1[ �'`�'I 'u(o <br /> gnaW�e o(OwnedConlraclodAulhorized Agent Date �/L <br /> I <br />