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� <br /> P�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STR�ET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> /a�� �9�� VE S� 1� (.ao�-3 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PNONE <br /> `'r � � � �1n�1 rn�s An .�od�-9��3 <br /> CONTRACTOR LI IT '7"'�� �/ ADDRESS CITY2IP PHONE <br /> 1 V /'1I /o p c� � �1 �TwKu��I�,�'��$ � <br /> CONTR.LICENSE# ���,.,_,�,_Qa,��4K � ^��1 <br /> 1� 1�.4� <br /> a�Y�— � <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric _Gas Other ,� <br /> WORK DESCRIPTION <br /> h�`{'� �uP����� 5�7�'� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling unils <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen�ink 8 disposal Gas'ireplace <br /> Dishwasher Ga;range <br /> Clolhes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floo�drain Refrigeralion <br /> _ Grease trap Woodstove <br /> _ Roof drains _ Other i4w �if����;� 5 <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give aulhoriry to vioiate or cancel ihe provision of any other state or local law regulaling construction or the perfortnance of <br /> construction.That I am authorized by the owner of this property to perform lhe work for which application is made and I comply with the <br /> State C clors Law 1827 RC nd 296200 WAC. ^ � <br /> G <br /> gn OwnedCo ract Date <br />