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PE�MIT APPLICATIO�v <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 /> ��l> S�d -� � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# ERMIT N <br /> �i 33� Ter���e �n.�� ooKR'�-so�sov�oa Z� - Ov� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> .De�- t4. M��-�'r��s 433� B '1'2�ra<< Or��o y�s 2sZ g2o'L <br /> TENANi NAME CONTACT FOR PERMIT PHONE <br /> VI� ��-t�� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> �klYti�C�' <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 5 IhI�L� F��I�IIU� ��51�J�/�K�` .�'Electric �Gas_Other <br /> WORK DESCRIPTION ,DLr�oI�5�1 �4Sn�j CkrR d G )( 3 � <br /> 6 /� �'C" .L <br /> �<E� �'i CA/' G^K✓°'r� 1s.r['rin -�'.tl.� Q�vC- <br /> S�ui,�: f�M,�y 2�`.'Sip��6 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> � Bathlub / Forced air systems <br /> � Lavalory(wash 6asin) � Gas piping <br /> Shower Waler heater <br /> I Kitchen sink 8 disposal � Gas fireplace <br /> J Qishwasher Gasrange <br /> J Golhes washer / Clothes dryer <br /> _ Laundry tray T Range hood <br /> _ Sink(service/bar/mop/etc.) � Exhausl fan <br /> Backflow prevenlcr Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease irap Woodslove <br /> Roof drains Other <br /> Other <br /> CIN OF EVERETT LOCAL SALES TAX COUE IS 3105 <br /> I hereby ceritify thal I have read and examinod Ihis app!ication and know the same to be true and correcL All provisions of laws and <br /> ordinace overning lhis type o�work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give ut ority to violale or cancel th2 provision of any other state or Iocai law regulaling construction or the performance of <br /> cons ucti .Thal I am aulhorized by lhe owner ot this property to pedorm the work for which applicalion is made and I comply with lhe <br /> Sta � ractors Law 18.27 RCW and 296.200 WAC. � <br /> , _� <br /> �� . ����� <br /> gn �re o�OwnedConhacroqAuthorized Agen! Date �I <br /> � <br />