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P�:RMI�' APPLICATIC►�l <br /> CITY OF EV�RETT PERMIT SER'VICES <br /> 3200 CEUAR STREET, EVERETT, lNA 98201 <br /> 425-257•�8810— FAX 425-257-8857—www.everetiwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT &CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS ,� PARCEL TAX I.D.# PERMIT# <br /> rao� ST s� �9 3i-lX�i -oog - �o M D,�o.s-oy <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITY2IP PHONE <br /> �D;�,� ��aG �iap ���e ,��o � �/�'STs�' ���y���3y25-z5z� y��� <br /> TENANT NAME CONTACT POR PERA7IT PHONE <br /> /3�u�' <br /> CONTRACTOR qFFc.COA�J�f 11FftT/NCdCcrY1NC qDDRESSSY�ryk�rl:/fb vw� CITY21P,ffit,/1tcL' HONE �ZS 3Y7 D�� <br /> �tla <br /> ySzsz <br /> CONTR.LICENSE# <br /> �(FCO /zffc9g/in�l 7-���� <br /> USE OF BUILDING HE T S� CONTRACT PRICE OF WORK <br /> _Electric �Gas_Other G��Q�� <br /> � <br /> WORK DESCRIPTION C l��� ,�� ��,er �-�y��,� J- ��(,( /�/L <br /> i <br /> 9R'�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _1_ A/C-air handling units <br /> � _� Balhtub �_ Forced air systems <br /> Lavalory(wash basin) Gas pipinc� <br /> � Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> Laundry lray Range hood <br /> Sink (service/badmop/etc.) Exhaust fan <br /> BackOow prevenier Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Flour drain Refriyeralion <br /> Grease lrep Woodslove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETf LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work wil�be complied with whelher specified herein or not.The granting of a permil does not presume <br /> to give aulhorily to violate or cancel the provision of any olher state or local Iaw regulating construction or the performance of <br /> conslruction.That I am authorized by lhe owner of this property to perform the work for which application is made and I comply wilh lhe � <br /> Slate Confractors Law 1E.27 RCW and 296.200 WAC. <br /> ���� S�.?3/a5" � <br /> Si ta2 of OwnedConlra✓ to/Authonzed Agent at� e <br />