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PE� .MIT AP�'LI���TiOh � <br /> C:ITY OF �VERETT PERMIT SERVIC�S <br /> 3200 CEDAR STREET, EVERETT, WA S8201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEFTED FRUM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEl.TAX I.D.# PERMIT# <br /> i` I � �2 �h 5�. �U P;c� i`y�� ' — � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CIT1'21P PHONE <br /> J/�rur3 �*' � TCI�,Lf�-N� q �l C�Ib�� ���e `[J4re}{� wA �j$,�o � yas- 896- 05� <br /> TENANT I�AME CONTACT FOR PERMIT PHONE <br /> SUSN rv ��2C S�n� (m�r�tC-�� �Urlc. ��t✓�ck�Uf��d (Id5 - ��G � io 5 d <br /> CONTRACTOR AODRESS CIN21P PHONE <br /> CONTR.LICENSE# <br /> Uw N rl�- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric � Gas Olher <br /> WORKDESCRIPTION �����.�n��a�.� ��. n ( �It�IrS�CI�IC��n� �QJ` `�j�OI�P �o( �Ll'GC� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUR[OF.ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> �athlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas(ireplace <br /> Dishwasher Gasranc�e <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Si�k(service/badmop/etc.) Exhaust fan <br /> Backflow prevenler Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drein Re(rigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY Of EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceritify that I have read and examined this applicalion and know the same lo be true and correct. All provisions of laws and <br /> ordinaces goveming this ype of work will be complied with whether specified herein or not The granling of a permit does not presume <br /> to give aulhonty to violate or cancel lhe provision of any other stale or local law regulating construction or the performance of <br /> consUuction.That I am authorized by lhe owner of this property to per(orm the wcrk for which applicalion is made and I comply wilh lhe <br /> State C6iltractors Law 18.27 CW and 2 6200 W C. <br /> ,,;�/'';%�.'jl/� ,�;;/%j;�'�� l� �/ rJS <br /> Sic�nalure of OwnedCont ctodAuthorized Agent Dale <br />. -- <br />