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I <br /> '� PL�ZMIT APPLICATIO�� <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 Phl - DEBIT 8 CREGIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS 9 E�I S I�'T H ��E � PARCEL TAX I.D.# PERMIT# <br /> � E.�E ���-c w�s ��i�ac�l o� Qo� ��c�c���oc; g���o8 -�,� <br /> L=GA LOTNO. BLOCK TRACT <br /> oesc� �� _.�00=� �G3050G � <br /> OWNER ADORESS CITY2IP PHONE <br /> s�-���� C�m�.r�T� �is iaT„��� W �ve.���� q��'� (4aS� 353 8a�\ <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> � <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTit.LICENSE X <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> _ElecMc �Gas_Ot!�er <br /> WORK DESCRIPTION <br /> ���,1� �m�� k�-v-�-Q <br /> '�;t,,,> i,n jc 6,;,ID� PLUMBING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> �� Baihtub �/ Forced air syslems <br /> � Lavatory(wash basin) v Gas piping <br /> h\ Shower ✓ Waterheater <br /> ��\Kitchen sink 8 disposal Gas fireplace <br /> � Dishwasher Gas range <br /> � Cla hes washer � C�othes dryer <br /> � Lau ry tray �L ange hood <br /> Sink rvice/barlmop/etc.) V E aust ian <br /> � Backilo reventer Hea ump <br /> Unnal Unit he er <br /> _ Dnnking Fo tain Boiler <br /> ' Ficor 3in 1 Refrigeretian <br /> Grease trap Woodstove <br /> �� � Roof drains Other <br /> Cther <br /> I <br /> CI1Y OF E'IERE'R LOCAL SALES TAX CO�E IS 1105 <br /> i hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this r�pe of work .vill te complied with whether specified herein or not.The granting of a permit does not presume <br /> ;e give authonty to violate or cancel the provision of any other state or local law regulating construction or the per(ormance of <br /> constructicn. That I am authonzed by the owner of this property to perform the work for which application is made and i comply v�ith the <br /> State Contracto Law 18.27 RC'N and 296.200 VJFC. <br /> C���''�- ��5��� <br /> ; , <br /> S�gnamre of r ontrac:orrAu[honzed Hgent Date /?i <br /> � <br />