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PErtMIT APPLICATiO�v <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 3 _.��—D � <br /> SITE ADDRESS j� PARCEL TAX I.D.# PERMI # <br /> �17J 3� % �— ✓C � �� � �/ <br />' LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ,!�o�Q xP��l�i 37i� /0�7�frS£ F,�r��`t� 33�- v3zs <br /> TENANT� CONTACT FOR PERMIT PHONE <br /> � <br /> lQ ai+ �7i'8�,�_ <br /> CONTRACTOLRL ADDRESS < CITY2�I,}PI PHONE <br /> G G / / NC� �L71"7� �vj�� � /���7✓1� /� /�t��rC I/ ��/ 2 <br /> CONTR.LICENSE# �� q /✓�S-l� �lJ� <br /> /d�.�J <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> , / Cr6 <br /> �����+ _Electric !�Gas_Olher �� ��(j� -i� I <br /> WORK DESCRIPTION <br /> 71' C3�« �.�:. l�s <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR fTEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Bathtub Forced air syslems <br /> Lavatary (wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink 8 disposal Gas fireplace <br /> � Dishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust(an <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERtTT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y lhal I have read and examined iliis application and knew the same lo be true and correcl. All provisions of laws ard <br /> ordinaces goveming this rype ot work will be complied with whether speci(ied herein or not.The granting of a pertnit does not presume <br /> to give authorily to violate or cancel lhe provision of any other state or local law regulating construc6on or lhe performance of <br /> construclion.Thal I am authorized by the owner of lhis pro{�erty to perform lhe work for which application is made and I comply wilh the <br /> St e Conir.3ctors La v 18.27 RCW and 296.200 WAC. <br /> � , ^'7 <br /> G <br /> $ig�ature o Owned cto Authorized Agent Date <br /> I <br /> '�i c �/z <br />� <br />