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PrRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /_�Q -0 6 <br /> SITE DDRESS PARCEL TAX I.D.# P .RMIT A� <br /> ���� � 'lin��--•,Ci���e v/ - D)a <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �S�S'�`�g`i <br /> � ��� � � ;�lr� ���� y.�l� 7�1 ��5 T,��,�,��'����.=v�,�� , <br /> TENANTNAME ONTACTFORPERMIT PH ,NE�"�' �� <br /> - � I � <br /> .�A6''�P5`!- Li-�J :j l_.,��r=�-�� ������� ' C� S `�'S-�-i�-`lCr4`7 <br /> CONTRACTOR L����� /r�,��� �J,t,;,h�j[."/Y- pD ES ITYfZIP . PHONE <br /> lu� � �� ��� i�j'�.� �=v::.,•�.4�.����t�?5:'_c4� y��s_?�'-�{cc:. <br /> CONTR.LICEI�SE p w�t V s <br /> y � � �� � Ihj I� - �� O �v <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � <br /> �`l� =' �� _Eleclric _Gas_Olher � ��C��; �'�r, <br /> WORK DESCRIPTION , .� , <br /> �c�; I ,;l..a..��:,�� ��-c, c-: �(i>{'�j �- r� r�-,i��?� �.�=-�-"� c� dw��S�n-� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilel A/C-air handling units <br /> _ Balhtub Forced air systems <br /> Lava�ory(wash basin) Gas piping <br /> � Shower Waterheater <br /> __ Kitchen sink& Jisposal Gas fireplace <br /> _ Dishwasher Gasrange <br /> _ Clolhes washer Clolhes dryer <br /> _ Wa�er healer Range hood <br /> _ Sink (service/bar/mo���elc.) Exhausl fan <br /> _ 6ackflow prevenler Heat pump <br /> _ Urinal Unil healer <br /> __ Drinkin� Foun�ain Boiler <br /> __ Floor drain Refrigeralion <br /> _ Grease trap Woodslove <br /> _ Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby cerilily Iha�I hav�read and examined lhis applicalion and hnow the same to be lrue and cortecL All provisions of laws and <br /> ordinaces governing Ihis type of work will be complied with whether speci(ied herein or not.The grenting of a pertnit does nol presume <br /> ro give aulhority lo violale or cance�ihe provisicn of any olher state or local law regulating consWction or the pertormance of <br /> wnslruclion.That I am aulhorized by the owner of ihis property to pertorm the work(or which application is made and 1 comply wilh the <br /> Stale Contractors Law 18.27 RCW and 296,200 WAC. <br /> /Y �� <br /> ---��-;(��---- l I�� i v � <br /> 4 ignalure of OwnedConhaclonnutnonzetl Agent Date <br />