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P`RMIT APPLICATI(..�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR S?REET, EVERETI', WA 98201 <br /> 425-257-8810— FAk 425-257-885'—www.everettwa.org �` �.3 <br /> ''Q5 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARD� ARE PiOT ACCEPTED <br /> SITIiADDRESS` N�/� � ��OS I PARCEL TAX I.D.# i ��R'M��� ^ <br /> Q.� n�r -�C <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. � <br /> OWNER fi ADDRESS CITY2IP PHONE <br /> 1 hti,k'��v� V(,�}�}1�' � � (OS� �I�►��n �" `�Z�I �?f l�f �b l8 <br /> TENA NAME CONTACT FOR PERMIT PHONE <br /> � r�w (�'A�t� p�4Le.�- <br /> CON�T�R�,A�C/T�OR ,� � �D �� �,C_A��ORESS, _,/� ���CI�rzIP PHONE <br /> �I,V,ryI VV �✓ii> 7 `� � Z-� <br /> 10 !i I r A�/ <br /> CONTR��LICENSE# TI,.b�I,, G(a^�� <br /> r� ��V !/ ( <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric Gas Other ��r�� • <br /> WORK DESCRIPTION <br /> II <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OP FIXTURE OR ITEM <br /> Toilet A/C–air handling unils <br /> Balhlub Forced air systems <br /> � Lavalory(wash basin) _ Gas piping <br /> Shower /' Water heater <br /> itchen sink 8 dispo��-� _ Gas fireplace <br /> _ D�hwasher Gasrange <br /> Clo s wa r Clothes dryer <br /> Laun ray Range hood <br /> �_ Si se 'ce/bar/mop/etc.) _ Exhaustian <br /> ack0ow p venler Heat pump <br /> Urinal Unil heater <br /> _ Drinking Fountai Boiler <br /> = Floor dra�n � _ Refrigeration <br /> Grease trap Woodslove <br /> Roo(drains � Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceriti(y thal I have read and examined this application and know lhe same to be true and correct. Ail provisions of laws and <br /> ordinaces governing lhis type o(work will be complied wilh whether specified herein or not.The c�ranling of a permit does nol presume <br /> to give authority lo violate or cancel the provision of any olher state or local law regulating construction or the perfortnance of <br /> construclion.That I a authorized by the owner of Ihis property to perform lhe work for which applir,ation is made and I comply with the <br /> Stale Con w 8.27 RCW and 296.200 WAC. <br /> 6� li l�� <br /> Signature of ontractedAuthorized Agent Date <br /> Yz <br />