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PEKMIT APPLICATION <br /> ClTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.evereitwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P M�T# <br /> �S o l �m r r �ve �o��' -� � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYlZIP PHONE <br /> ,�L L Sf • l/I�c�C'.�i91��7S �O. �oX S�S�'t '�P�tG�• <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> n�«�i4cC /'v�k-itc�9��4c7�i�rrc� �rc�r �4�tlson� �ZS=339-?Fs7,Z <br /> �CON ACTOR ' ADDRESS C N/ZIP PHONE <br /> t�R-NSo� M�.C{��4>v�ca.Q /�c�s�' vY1c�£� ���T38u. c,c��3�'�-t78 7 <br /> CONTR.LICENSE`Ni.��'c _�� <br /> V ����L <br /> USE OF BUILDING HEAT SOURCE CO%�TRACT PRICE OF WORK <br /> �O <br /> iM��� �C�p� _Eleclric _Gas_Olher �— <br /> �.�/ "�/(— <br /> WORK DE CRIPTION � �80� <br /> y�(�U`vl��/U��2 �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel FVC—air handling units <br /> Bath!ub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower W ater heater <br /> � Kitchen sinY,8 disposal _ Gas fireplace <br /> Dishwashcr Gasrange <br /> Clolhes washer Clolhes dryer <br /> Water healer Range hood <br /> Sink(serviceNaumop/elc.) _ Exhaust fan <br /> �ackflow prevenler _ Heal pump <br /> � Urinat _ Unit healer <br /> Drinking Founlain _ Boiler <br /> i Floor drain _ Refrigeration <br /> Grease lrap _ Woodstove <br /> Roof drain � _ Olher <br /> � Olher G � _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby cerilify Ihat I have reaA and examined Ihis applicalion and know ihe samc lo be lrue and correct. All provisions ol laws and <br /> ordinaces goveming this type of work will be complied wi:h whelher specified herein or nol.The granting of a permit does no�presume <br /> to give authoriry lo viol2le or carcel ihe provision ol any olher state or Iocal law regulaling construction or the peAormance o1 <br /> construction.That I am authorizeA by�he owner of Ihis property to pcdorm Ihe work for which appiication s made and I comply wilh the <br /> Slate Cont actors Law 18.2 VJ and 296.200 WAC. <br /> ' u�c�'/c z-23�_ <br /> Signa ure o Owneu�ontractor/Authorized Agenl Date <br />