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P"RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org .� -3 —05 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I,D. # PERMIT# <br /> // - 79x4 /;/ :�r" I <br /> ILEGAQ LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITy21P PHONE <br /> 97Zd� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE / <br /> CONTRACTOR //te�r DRESS .0 CITY2IP �y PHONE <br /> G"/j�iiti.�i 437 `JPz ✓�Li c 3/C6 Gnl�r..[//�.'� —Lv,vr/ ''fr�.�—�'� <br /> CONTR.LICENSE# <br /> _ Z-Y!_9,y�5oNz. z yz - zsi-? 1,ir/ <br /> USE OF BUILDINGI MEAT SOURCE I CONTRACT PRICE OF WORK <br /> — <br /> Electric Gas Other <br /> WORK DESCRIPTION p �� <br /> P-6 I�` Ile, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE:OF FIXTURE OR ITEM <br /> _ Toilet A/C— handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas pipini <br /> _ Shower Water heats <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow prevenler Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certify 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 type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contr ctors La".g7 RCW and 296.200 WAC. <br /> z lCr ) �s-iL- 0 :y- <br /> Signature <br /> - <br /> Signatur— o� wwnner/ ontractorlAuthorized Agent Daie <br />