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PCRM��' APPLICATION <br />C�TY 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 d�I ��� L� � PARCEL TAX I.D. # � PEf�2M1T #_ , <br />ev�kET�, �.�.� 93�1�� <br />LOTNO. BLOCK <br />TRACT <br />-oo <br />Z5 <br />OWNER AUDRE55 CITY2IP PHONE l�,�"_7y7 c��� <br />/�51�SL-/f ia• L'l1�Ayi} 6 i.5-G/3 NE /�t �f9• �2//rvr�C Gc�9-�i�'c�d� <br />TENANT NAME CONTACT FOR PERMI7 PHONE <br />jZG'u/Ef✓k Gti• /�'I'i//er %�OU,'�N.d (>. /�Ii//ti �/ah=y�3-Go�v _ <br />CONTRACTOR ��� ADDP.ESS CITY2IP PHOTIE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />/+ D�'1�T FAN1 iL <br />WORK DESCRIPTION <br />Nc�E <br />NO. I hPF. OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitclien sin4 & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/badmop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ Electric �Gas __ Other <br />CONTRACT PRICE OF WORK <br />N0. � TYPE OF FIXTURE OR ITEM <br />A/C — air handting unils <br />Forced airsystems <br />Gas piping <br />W�ter heater <br />Gas fireplacc <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhauslfa�i <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigerelion <br />Woods:ove <br />Other __ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby ceritity lhat I have read and examined this application and know lhe saine to be true and correct. All provisions of laws and <br />ordinaces governing lhis lype of work will be complied wilh wl�ether specified herein or not. The granting of a permit doos not presume <br />to give authority to violate or cancel lhe provision of any olher slate or local law regulating construction or the per(ormance o( <br />consiruclion. That I arr �ulhorized by lho owner of lhis property to per(orm lhe work for which applicafion is made and I comply with lhe <br />Slate Contractors Law 16.27 RCW and 296.200 WAC. <br />C <br />