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PERMiT APPLlCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857—www.evereitwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � ���`�J <br /> SITE ADDRESS PARCEL TAX I.D.i! PERMIT k <br /> 12800 l�atliell-�Je�ett fFy ,�c�� - C�.-I <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION 1! <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> Prov'id,.enc.e. �z800 13atl�e.11-Evecett dw� �Je�ett wA g� zo8 <br /> TENANTNAME CONTACTFORPERMIT PHONE3(o0 lo�� Hl�13 <br /> P�DUIQCI�IC.P� �2.��, 5to�rn E•MAILCCi�,s@ua,tsi9r��o.c.o„� <br /> CO RA v�����eC 5i0.n A E 5 CITY21 E 3bG 6�t3 1(Z7 <br /> � �(� �5 ti1E N wV �9 UanLo�we� tti1A <br /> CONTF.LICEt1SE q <br /> VRNC.oS'� 25B Sc, �8665 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Me�.�u�-� _Electric _Gas_Olher I �� <br /> WORKDESCRIPTION Si„n '.L $;y\,.�`C �ac.e., flo(1. �i���l.M�na-Ye�, c��fB�*.oCU Sic�Yl <br /> _L_ J <br /> G� tall, z'�`� � 5�9n�ye <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE CR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling uni�s <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Ki�chen sink 8 disposal _ Gas fin.place <br /> Disliwasher _ Gas range <br /> Clo�hes washer _ Clothes dryer <br /> Water hea�er _ Range hood <br /> ._ Sink(service/badmop/e�c.) _ Exhaust lan <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> _ Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woods�ove <br /> Roof drains _ Other <br />�' --- Other _ I <br /> I -- --- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceri�i(y thal I have read and examined Ihis applicalion and know ihe same to be hue and correct. All provisions ol laws and <br /> ordi�aces goveming Ihis type ol work will be complied with whether specified herein or not The gran�ing ol a permit does no�presume <br /> to give authority lo violate or cancel ihe provision ol any other state or local law regulating construction or ihe performance of <br /> consiruclion.That I an��authorized by ihe owner of Ihis property to perform the work tor which application is made and I comply with the <br /> State Coniractors Law 18.27 RCW and 296200 WAC. <br /> Signature ol OwnedContractodAuthorized Agent Date �/ <br /> � <br /> � <br />