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P'tRMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8E57-www.everektwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TQ 4 PM G-ap-O� <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> ; S �, S / ` Ti�r ,�1VC S E _��Z— <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AUDRESS CITY/ZIP PHONE <br /> J�Ai�1E5 l7�Sn?UL �i ���- 1-lrs7 hii� S� EvE2 �T1 t�/A �as379-siss <br /> TENANT NAME CONTACT FOR PERMIT � PHONE <br /> T2cPiTAN/� T�;�v�ii,ciG�d�Si�2€.z�J :JirarES DEJNIuL y,15 379 - �iSS <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> J,�N� �G1 _Eleclric _Gas_Olher <br /> WORK DESCRIPTION <br /> �>�T � � D wi+��, i�� STi��� �oa �?. _ <br /> PLUMBING hAECHANiGAL <br /> NO. TYPE Of FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet l�IC—alr handling unils <br /> Bathlub Forced air systems <br /> Lavatory (wash basin) _ Gas piping <br /> Shower _ Waler healer <br /> Kilchen sink&Aisposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust fan <br /> Backflo�v preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Fcuntain _ Boiler <br /> Floor drain Refrig eralion <br /> Grease Irap _ Woodst�ve <br /> Roof drains Other, <br /> Olher — <br /> CITY OF EVERETT LCCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined this application and know ihe same lo be true and correct. All provisions of laws and <br /> ordinaces yoveming this type o(work will be complied�vilh�ti�hether specified herein or not The granting of a permit does not presume <br /> to c�ive au,hority to violate or cancel the provision o(any other stale or local law regulating consWction or:he performance of <br /> r.onstruction.That I am aulltorized by the owner of this property to perform the work(or which application is made and I comply wilh the <br /> State Contraclors Law 18.27 RCW and 296200 WAC. <br /> n «�.� �-�/�J�1 � �'/a a l o � <br /> Sic�rt lure o(OwnedContractodAuthorized Agent Date �/ <br /> Z <br />