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P�RMIT APPLICATI(�N <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS T �ARCEL TAl(I.D.# PERMIT# <br /> �� `��tl.�S S-� �(.V�G �zJ <br /> � LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> � n f O���V� l! � IC 1� rC1 <br /> TENANT NAME CON,TACT F R PERMIT� PHONE <br /> (/� ' \ u � ,'.)� <br /> CONTRACTOR /�J• w � vw� Sp`�1'�,rsADDRESS � yZlYl N-f / 7/�CITY2IP PHONEN1S=�f�/ .�iyJ'� <br /> �l.l'G-rl��v.11� 4+�j <br /> CONTR.LICENSE# A�OV'T��ls cI 7 � �M p /,-� <br /> �'r'�, v�� <br /> USE OF BUILDING I HEAT SOURCE � CONTRACT PRICE OF WORK <br /> /\Electric Gas Other ��D� <br /> i <br /> WORK DESCRIPTION <br /> f���t�� �"�-- ��� � I � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fIXTURE OR ITEM NO. TYPE OF F�XTURE OR ITEM <br /> �� Toilet _ A/C—air handlinq nnits <br /> 9 Balhlub _ Forced air systems <br /> � Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> _ Water heater Range hood <br /> Sink(service/badmop/etc.) � Exhaust fan <br /> Backflow prevenler Heatpump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> �loor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined lhis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing lhis lype of work will be complied wilh whether specified horein or nol.The granting of a pertnit does nnt presume <br /> to give aulhority to violate or cancel the provision of any other state or local law regulating construction or the perfortnance of <br /> construction.That 1 am authorized by the owner of this propeRy lo perform the work for which application is made and I comply with the <br /> Slale onlraclors w 18.27 RCW and 296.200 WAC. <br /> �v� ��: lJ- - l3-OS� <br /> Signa ure of OwnedContractor/Authorized�gent Date D <br /> � � <br />