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P�RMIT APP�.ICATI�I <br /> CITY OF EVERETT P'ERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857 —www.everettwa.org �_g�� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT &CREDIT CARDS ARE NOT ACCEPTED <br /> SI7E ADDRES� PARCEL TAX I.D.# P RMIT# <br /> (IaZO �ii`` Avcnvt, SC �� �� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> i3qc��11 p�.,Ss <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> CONTRACTOR n p �NCSU�� �Cc� ADDRESS CITY2IP PHONE <br /> W K- �/Z�� <br /> CONTR.LICENSE# �/' <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric _Gas_Other <br /> WORKDESCRIPTION In�i�.�� CO�c1zqS�nS U��ti cn QOO� T�r' ����C �U,�cic�ciS In <br /> �.1��k--i^ Gevlei e Cre�zr� 1, �,�# C3a503 -C110 <br /> ' (,f r�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C–air handling units <br /> Bathlub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Cblhes dryer <br /> Laundry lray _ Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust fan <br /> Backfiow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fowitain Boiler <br /> Floor drain �_ Refrigeralion <br /> ` Grease lrap _ Woodstove <br /> Roo(drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> I hereby cerilify lhal I have read and examined this applicalion and know the same to be true and correcL All provisions of laws and <br /> ordinaces governing lhis type of wurk will be complied with whether specified herein or not.The granling of a permit does not presume , <br /> to give aulhonty to violale or cancel the provision of any o�her state or local law regulaling construction or the perfortnance of <br /> construction.That I am authorized by the owner ot this property to perform the work forwhich application is made and I comply with the <br /> State Conlractors Law 18.27 RCW and 296.200 WAC. <br /> .��- ,�-��- <br /> SignaWre o(O nedContractodAyt�ionzed Agent Date <br />