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PtRMIT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA�8201 <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.# PERM T <br /> 23 � 3 6T�' s � �/��� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION b <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> 3Rm� 5 /2c.=�. yGTrlr � � 2303 �'rN 'i• � V�R� r <('z.5' 3/ 7-9�/ 7 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> E•MAIL <br /> CONTRACTOR ADDRESS CIT IZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING /j�N�,� L HEAT SOURCE CONTRACT PRICE OF WORK <br /> � � <br /> ��L S���L�� G" /-� tM / �� �Electric __Gas Other <br /> WORK DESCRIPTION <br /> `l�� ni r �0 2� M <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet !VC—air handling unils <br /> Balhtu6 Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink 6 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Water healer Rango hood <br /> Sink(service/bar/mop/elc.) _ Exhaust tan <br /> 6ackllow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Re(rigeration <br /> Grease Irap _ Woodstove <br /> = Roof drains — I _ Other <br /> Other _ <br /> Pc;,Z� (� — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y ihal I have read and examined lhis application and know lhe same lo be true and correct. All provisions of laws and <br /> ordinaces goveming lhis lype o(work will be complied with whelher specified herein or nol The granting o(a permil does not presume <br /> to give authoriry to violzte or cancel lhc provision ot any olher s;ate or local law regulating consiruclion or the performance of <br /> construction.Thal I am authorized by lhe owner of this properly lo perform ihe work for which application is made and I comply wilh the <br /> Slaie Contractors Law 8.27 CW and '296.200 WAC. <br /> � -- �D 6 <br /> Sigp� ure � wner/�ontractor/AulhoizedAgent Dat � <br /> ! <br /> � l Z <br />