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/ <br /> PERMIT ARPLICATIUN <br /> CITY OF EVERETT FERMiT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WF�98201 <br /> 425-257-8810- FAX•._5-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 �:WI TO 4 PM $_a�_�� <br /> , _. <br /> 51TE ADDRESS y �Gp� PARCEL TAX I.D.# PERMIT# <br /> S� �� .:23'—`� i���. W LVCV2/�l c,.,+ 1"���U �-�/3� <br /> LEGAL LOT NO. BI.00K TRACT OR SUBDIVISION# <br /> D[SC. <br /> ��,�;��k AUDRESS CITYIZIP PHONE <br /> �.;-w N1'��I�elle V�,nke�- �s��,-,e � ��6}�syo��y <br /> TENANT NAME I CONTACT FOR PERI7IT PHONE <br /> E-MAIL <br /> CONTRACTOR ADDRESS CITYIZIP PH NE <br /> CONTR.LICENSE# <br /> CJ�,7 ti�c � _ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric Gas Olher <br /> WORK DESCRIPTION <br /> '� �..-% 2 c c- r ,�n/ E ��° �'e.�, �, � o � (� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling unils <br /> Balhlub Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water heat;r <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/badmop/etc.) _ Exhaust(an <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and e,cani�iied L';ic sppfcatien and know the same to be lrue and correcL All provisions of laws and I <br /> nr�i�nacos noverniny this type of work will be compli�d with whether specified herein or not.The grantiny of a permil does not presume i <br /> to 9ive authority to viqlai�e� :.an:;el th? ;��ovi�ie�nf any other s!ate or local law re�ulaling r,onsWction or the peAormance of <br /> conslr�ction. Thal Pam aulhorized by Ihe owner o(this property lo periorm the work for which application is rr�ade ana i cornply wi�h tne <br /> Slate Co•it2ctors Law 18.27 RCW and 296.200 WAC. <br /> % �\ ` ��l i��'�+' <br /> gjg WJ c�o(uwnedContractor/Authorized Agent Date <br /> , � ,; _ — -- <br /> G� <br />