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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> "� l� 'v �- J�, MC' 71I-i 5G <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �3 r << ������� I �. w� �� r s � "�^�--r �o ,��' �;��.�.�r���=�'�� � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL "� <br /> CONTRACTOR /11�..� `! �i Gr�.. 1'�� 3i���5� �br f Q�� „(� CI�I�IPI W6 �La �'c� �f J D / <br /> (i� �y ! l <br /> � <br /> CONTH.LICENSE#�� �� �,� I�� �� I`rt <br /> U�'1 <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> __Eleclric _Gas_Other � (� � � � <br /> WORIS DESCRIPTION `J'�4�i,y� ��d f,�,f„� � L�„��� �� �ti„�� � <br /> l� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathlub �_ Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shuwer Water healer <br /> Kitchen sink&disposal Gas ireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clofhes dryer <br /> Water heater Range hood <br /> Sink (scrvice/bar/mop/etc.) F.xhausl fan <br /> Back(low preventer �_ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined lhis application and know lhe same to be true and wrrecl All provisions of laws and <br /> ordinaces�overning this type of work will be complied with whelher spccified herein or noL The granting of a permit does not presume <br /> to gica authority to violale or cancei the provision of any other slate or local law rec�ulating conslruction or lhe pertormance of <br /> constr:�ction.That I am authorized by the owner of Ihis properly lo perform lhe work for which application is inade ard I comply with lhe <br /> State(:ontractors Law 18.27 RCW and 296200 WAC. <br /> .�� c �'�.:M�-� ��_� ��— � ( <br /> Signalur o OwnedCo ractodP,uthorized Agenl Date <br />