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P��RMI� APPLICATI(.,N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> �125-257-8810-FAX 425-257-8857-wvuw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED PROM 8 AM TO 4 PM � al(-B�o <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �z�t `I �s�" S� SW E�z;..� c�o� oo ' 2 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> '�V111Z� � �illl�l' � LZ 1 `'f�l,� �� JW �rl�Pll'.11 IUZI�J �IZS ' ICC_G���� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> CONTRACTOR �c��� ADDRESS CITY2IP PHONE <br /> CONTR.I.ICENSE# <br /> USE OF BUILDING I HEAT 50URCE I CONTRACT P'tICE OF WORK <br /> (_'..oe„$l.� a Lc,r:,c��., � � <br /> �Electric _Gas_Other L,S,�� <br /> WORK DESCRIPTION 1 1– i <br /> Cio�\V�is�p�� J� �r rc}2. i�`�a � t'G���ly rGU�M G� <br /> 1 <br /> (il ����"C� KG�LV� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C—air handling units <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Waterheater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer _ Clolhes dryer <br /> — n, y Range hood � <br /> S nk(serv ce/bar/mop/etc.) � Exhaust fan jQ <br /> ^ Backflow prevenler _ Heat pump <br /> Urinal _ Unit heater <br /> _ Drinking Founlain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other a - c� � <br /> Other °'`� `� <br /> CITY OF EVERETT LOCAL SALEs TA%CODE IS 3105 <br /> I hereby ceritify�hat I have read and examined lhis application and know tl�e same to be true and correct. All provisions of laws and <br /> ordinaces governing this lype of work will be complied with whether specifad herein or not.The granting of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any olher state or local law regulaling construction or the performance of <br /> construclion.That I am authorized by the owner of this properry to perform the work for which application is made and I compiy with the <br /> State Ccnlractors Law 18.27 RCW and 296.200 WAC. <br /> �l� "��.i ���iC- 1 U-z I-c�S <br /> Sig alure of OwnedConlrec orlAuthorized Agenl Date ^ / <br /> I " V <br /> � <br />