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F� cRMIT APPLICATIVN <br /> CITY OF �VERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 42F 257-8857—www.evereKwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �" a- Q /(� <br /> SITE ADDRE55 � PARCEL TAX I.D.# PERMIT# <br /> �l t7� Si �VEI� D�C-c Btv x�0��-�� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> t� I Z I iJ � 1-I 1 �/j� SU CH I �.1� ���1� � H I N E-MAIL�6 �' S��I �-d <br /> �6RYkACT6R su i � — <br /> W�S( CoaST P(L�P�Yy �2s�� �� rb3s� w�a�,N����c <br /> CONTR.UCENSE p 1 ' C �T C �,✓A ,�8 0 7� <br /> w Q!�'� O �-'� �'U <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OP WORK <br /> � t �'(�"V 2�"T�� _Electric �as_Other � � � � n� <br /> WORK DESCRIPTION <br /> Pf=ov� � r n�vr� �Si �(� � �AS �� P�N4 jq c.�o ���y <br /> E4U� �' tit �I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> 2 Toilet A/C-air handling units <br /> [3alhtub - Porced air systems <br /> �,� Lavalory(wash basin� � _[_ Gas piping <br /> Shower _L Water heater • <br /> Kllchen sink 8 disposal _ Gas fireplace � <br /> �— Dishwasher � � Gas range <br /> Clothes washer . � - Clolhes dryer <br /> � Wa�er heater � Range hood <br /> ,� Sink (servicelbadmop/etc.) Exhaust fan <br /> BackOow preventer Hea�pump <br /> Urinal —� 14�i1-iw�iw- � ��� t^�� <br /> Drinking Fountain � Bc�ar /32� i���� <br /> _f_ Floor drain _ Refrigeretion <br /> __(_ Grease trap � Woodslove <br /> Roof drains �r� � Other W l� � <br /> I Other �i f'-E�S� �1 Y�`�f <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> I hereby certi(y that I have read anJ ezamined Ihis applicalion and know Ihe same to be true and correct. All provi��ons of laws and <br /> ordinances governiny Ihis type of work will be complied wi�h whether speci6ed herein or not.The granting of a pemi�t does not presume <br /> to give aulhonty lo vioia,a nr cancel Ihe provision o(any other s�ale or local law regulating cons�rudion or Ihe periormance of <br /> construction.?hat I am authorized by the owner of this properly to perfoim the work tor which appiication is made and I compy�with the <br /> Stale Contractors Law 7827 RCW and 296 200 WAC. <br /> � ��� � - 2 B- /o <br /> SignaWre ol OwnedCo tractod�ed Agent Date <br /> �-- ----- --. ._ _. . _._ - -.. __ . __ ..------ -- �- — — <br />