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FERMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P MIT# ^ <br /> �.�{ `'�' � �r�� �,�� <br /> IEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITY/ZIP PHONE Y�S 3� � <br /> �-LC�D� /;c.v� �f �Sr�n��.ou,v� 7Jl/ (e`�`� �a G✓. h� Sf7o3 � S�"7 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR �n���p ���,.�,,,�/�U L A�D 3 jSs �`�y� �+�, �£ CITY2IP PHONE <br /> /' �y,�� 3r37-1s..�7 <br /> CONTR.LICENSE p�I�(iLG� /7O�M%5 �� ,�J��V7 J v,�,GCP� U�i - �7'�S <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION �\,�u��• W��I�/ ��� ��,�„�� �S�t�G � `�"�'�`P <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilel A/C–air handling unils <br /> _ Bathlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> _ Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> _ Sink(service/barlmop/elc.) Exhaust fan <br /> _ Back(low prevenler Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Retrigeralion <br /> Grease Irap Woodslove <br /> Roof drains Other <br /> Other Gdl1;,'"/1 1 i/J1 <br /> CITY OF EV�RETT IOCAL SALES TA:(CODE IS 3105 <br /> I heret�y cerili(y that I have read and examined this applicalion and know lhe same to be lrue and correct. All provisions of laws and <br /> ordinaces governing ihis type of work will be complied wilh whether specified herein or not.The grenting of a permit does nol presume <br /> to give aulhority to violale or cancel the provision of any other state or local law regulating construclion or the performance of <br /> construction.Thal I am authorized by the owner of lhis property to perform lhe work for which applicalior,is made and I comply with the <br /> State Conlrapinrs 4aw 18.27 RCW and 296.200 WAC. <br /> �� -� _ : �%:.>' �:� �,., b� i1,�nG- <br /> Signature ot OwnedContractor(Ay[thon ed A ent � ' Dat2 <br /> r <br />