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PERMIT APPLICATIdN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM 5- a s-o� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT 1� <br /> �3 � /e��,��ce� �r. /'�I �� -4 7 <br /> LEGAL l0T NO. BLOCK�TRACT OR SUBDIVISION N <br /> DESC. I <br /> OWNER ADDRESS CITY2IP PHONE <br /> �i �-r�b�°����� ��vcti'�lG <br /> TENANT NAME � � CONTACT FOR PERMIT PHONE <br /> ��i���� �t�� ��-S.`���?. 4��� <br /> CONTRACTOR ADDRESS CIN21P PHONE <br /> CONTR.LICENSE# (�`.����/C.� <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eieclric Gas VOther <br /> WORKDESCRIPTION /)�n/�; � ���,�����, /�rk.�/ �N/rL `'�-Y1 �(i[ -t/ <br /> �� r� <br /> — J�(��„� h lTt S <br /> ¢r <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air hantlling units <br /> Balhtub orced air systems <br /> Lavalory(wash basin) Ga�piping <br /> Shower Waler heater <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes v.•asher C�olhes dryer <br /> Water heater Rango hood <br /> Sink(serviceNar/mop/elc.) Exhaust fan <br /> BackOow preventer Heat pump <br /> Urina� Unil heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodslove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J105 <br /> t hereby ceritify that I have read and examined lhis application and know the same to he true and correct. All provisions of laws and <br /> ordinaces governing this lype of work will be complied with whether speci(ied herein or not.The granting of a pertnil does not presume <br /> to give authority to vio�ate or cancel the provision of any other state or local law reguiating construction or lhe pedormance of <br /> constmction.That I am aulhorized by tha owner of this property lo pedorm the work for which appliwtion is made and I compiy with the <br /> State Contraclors Law 18.27 RCW and 296.200 WAC. <br /> . ^ C ? <br /> ��-,� l:r'�:' c!�%, � :�� , -. ._,._� �'-,' .,, S-�c'� <br /> 3ignature of Owne�Eohtracto Authorized gent Date <br /> i� <br /> v <br />