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PcRMIT APPLICA'1'[CrN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —�vww.everettwa.org <br /> APPLlCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> :iITE ADDRESS �� i PARCEL TAX I.D.# PERMIT# <br /> ✓ ', ;_ `'3 5 S� � 1- r',���C� <br /> LFGAL LOT NO. BLOCK TRACT OR SUB�IVISION# i_' ` �- > ?{ c7') <br /> DESC. ) "`� CIJ � �S I <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> 5 ,�ti,<,t << <� �3 � � � � � �'��� t � �� �� � �t-� � � .� <br /> v f. �a � z, i �_ � 1_; � V R �' «�, <br /> TENANT NAME !f/ CONTACT FOIt PERMIT PHONE <br /> ,_ -�- " �� <br /> �•::f.U�\-.�;�•.rif;= _' . ., E-MAIL <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> CONTR. LICENSE tJ � 7�/v����� , <br /> / <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK I <br /> �} "-��_? _Electric �Gas__Olher ����� _ � <br /> WORK DESCRIPTION <br /> ���v� ��..:� �� .��nG .1Y� �l�'..J �i.,-r�..nc -t� rlZ,,.� CC s ��i'N`��C:�2 , ,r <br /> L) �� � <br /> I'le k% �,�JC�-i/1 �?i�A.-Z. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilel A/C-air handliny unils <br /> Bathtub � Forced air systems <br /> _ Lavalory (wash basin) � Gas piping <br /> _ Shower � Water healeY <br /> Kitchen sink&disposal � 4' Gas(ireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Clothes drycr <br /> Water healer Range hood <br /> Sink(service/badmop/elc.) 6xhaust(an <br /> Backflow preventer Heal pump <br /> Urinal Unit heater <br /> Drinkiny �ounlain Boiler <br /> Floor drain Refrigeration <br /> Grcase lrap VUaodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceriti(v that I have read and examined lhis application and know the same l0 6e true and correcL All provisions ot laws and <br /> ordinaces goveming Qiis type o(work will be complied with whelher spaci(ied herein or nol The granling of a permil does nol presume <br /> to give authority to violate or cancel lhe provision of any olher state or local law regulalin9 construction or the peAormance of <br /> construction.That I am aulhurized by Ihe owner of this property to pedorm�he work for which application is made and I comply with the <br /> Slate Co�traclors Law 18.27 RCW and 296.200 WAC. <br /> , <br /> _ . � _ i".. .- �� k\_ � - <br /> SlgnaWPe ot OwnedContractodAulhorized Agent Date ' <br />