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P��RMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# I <br /> �ar3o �'� �-�e SE cx3�7ooaao (qo� � -�J I <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PNONE <br /> �t'e To�.��H� lGl3D 7f� /4uZ $� �LP�e�/� 98108 ��f�S)7y�'y6Ta <br /> TENANTNAME CONTACTFORPERMIT PHONE (C(as���(� - �I6T0 <br /> '��C '�-�` /Q� <br /> 7- e.Ma� <br /> TRA R DRE I <br /> CONTR.LICENSE# <br /> USE OF BUILDING HCAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric/\ Gas Olher <br /> WORK DESCRIPTION <br /> �ew qk.S P�� `}�trovyho� {��5� �vi /u-ai /�ti�i-�a� a� aJ �jer�/Pi <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> = Shower � Water healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop�etc.) Exhaust(an <br /> Backflow preventer Heat pump <br /> Urinal Uriit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeralion <br /> _ Grease trap Woodstove <br /> Rootdrains � Other /jBGl <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby centi(y thal I have read and ezamined lhis applicalion and know lhe same lo be lrue and wrrecl. All provisions of laws and <br /> ordinaces governing lhis lype of work�vill be complied wilh whether specified hetein or not.The granting of a permit does not presume <br /> to give authorily to viulale or cancel the provision of any olher stale or local law regulating consWclion or the pedormance of <br /> co�istruction.That I am authorized by the owner of this property lo per(orm the work for which applicatlon is made and I comply wilh the <br /> State Contraclors Law 18.27 RCW and 296.200 WAC. <br /> �/ �i� 7-�D-o7 <br /> Si�ature of OwnedContractor/Authorized Agent Date <br />