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PERIVIIT APPLICATION <br /> CITY QF EVERETT PERMIT' SERVICES <br /> 3200 CEDAR STf�EET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIOPI.c, ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � p �.. � ��1 S� S C f S � � � <br />� LEG.4L LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY21(�, ��3 PHONE <br /> �u �� �, '��� r c �1 �U u`c , r'� �C U -� � � I-(� St S E �C �e ret-f �} a 5 3 5`1 - lo l � I <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> CONTRACTOR ADDRESS CITYIZIP PH NE <br /> CONTR.LICENSE# <br /> USE Gr :su'ILDING HEAT SOURCE CONTRACT PRF,.c OF WORK <br /> Electric Gas Olher <br /> WORK DES�RIPTION <br /> '(`� � \a c � i.�c�-�-e� �e r�-k e '� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI}:TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling unils <br /> BalhWb Forced air syslems <br /> Lavatory(wash 6asin) _ Gas piping <br /> Shower Waler healer <br /> Kilchen sink 8 disposal Gas liraplace <br /> Dishwasher Gas range <br /> Clothes�vasher Clolhes dryer i <br /> Waler healer Range hood <br /> Sink(servicelbadmop/elc.) _ Exhaust fan <br />, Backflow prevenler __ Heal pump <br /> Urinal Unit healer <br /> Drinkinc� Founlain _ Boiler <br /> Floor drain Refrigerelion <br /> Grease trap _ Woodslove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y lhal I have read and examined this applicalion and know the same lo be lrue and correcL All provisions o(laws and <br /> ordinaces governing Ihis type of work v;ill be complied wilh whether specitied herein or not The granting o(a permit does not presume <br /> lo give authority lu violale or cancel the provlsion of any olher slate or local law regula!ing construction or the per�ormance of <br /> consiructiun. That I am authorizod by lhe owner ot this pmperty to pedorm the work for which application is made and I comply wilh lhe <br /> St te Contractors Law 18.27 RCW and 296.200 WAC. �I <br /> �-�. C ��. c��-c�...,_,:_ l 0 / 1 7 0 �� � <br /> Sign ture of OwnedConlreclodPuthorized Agent Date i <br /> I <br />�-- -- - — --- — <br />