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PtRMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CECAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED_FROM.BANI TO 4 PM <br /> SITE ADDRE5S C?ARCEL TAX I. PERMIT N <br /> -f .Du ��/' c�C2_ �� TSOI FivIGO � (�0 -3 � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> WNER ADDRESS CITY2IP PHONE 4ZS— <br /> ��Ci����'1 �C,C�%'C� `t ��� ��d/Gf� d(��=-<'`olG�� �� �D� �Sz � 2 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> %!/O i/u- <br /> I:ONTRACTOR �^ AODRESS CITYIZIP PHONE <br /> ��l�C/�/l�' ✓ <br /> CONTR.LICENSE# <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �}'`-- _Electric _Gas_Other Z �v <br /> WORK,A�SCRIPTION � <br /> �1 � � �� ,� � <br /> "� c, �„�,�t� ��r..�;^/'u a l�.j ��G.��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> �� Toilet _ A/C—air handling unils <br /> � P3lhlub _ Forced air systems <br /> �_ Lavatory(wash basin) _ Gas piping <br /> � Shower Waterhealer <br /> Kilchen sink 8 disposal _ Gas(ireplace <br /> � Dishwasher _ Gas range <br /> Clolhes washer Cblhes dryer <br /> Weler heater Range hood <br /> Sink(servicelbadmop/elc.) = Exhausl fan <br /> Backllow prevenler _ Heat pump /% <br /> Urinal _ Unit healer /I �� <br /> _ Drinking Founlain _ Boiler � ,�F� <br /> Floor drain _ Refrigeralion � ,^ 7 �Uj <br /> Grease Irap _ W'oodstove <br /> Roo(drains ��hef ��yG <br /> Olher <br /> CITY OF EVERETT LCCAL SALES TA%CODE IS 3705 <br /> I hereby cerilify Ihat I have read and examined Ihis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming lhis type of werk will be complied wilh whelher specified herein or nol The granting of a pertnit does nol presume <br /> to give authnrily to violate or cancel the provision o(any other state or local law regulatinc�wnstruction or the peAormance of <br /> construction.Thal I am auth6)ized by the ner of lhis property to pertorm Ihe work for which application is made and I comply with the <br /> Slale Co�}il acbr Law 182J�RCW and 2 200 WAC. <br /> ,' ��--r 1' �'��sv � - �; 'o� <br /> Signature of vne CoNraclodAulhonzed Agent Da�e <br />