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PERMIT APPLICATIuN <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 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS _ PARCEL TAX I.D.B PERMITS <br /> LI - `79 4L PC - <br /> LEGA LOT NO. BLOCK TRACT /� o5o9-0G ) <br /> DESC. l� <br /> OWNER ADDRE33 PHONE <br /> �12tlJT RIA&C'.LICC 1 210 7911. PL tJ • cveiLm )WZoS <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> SU h1tjA/J(7 Zo6 3z; >y (_I <br /> CONTRACTOR Z ,, ADDRESS CITY2113 PHONE <br /> j�t2b Dr U /c3 /0 a I t,r Ave. S • SL'"ATfi__E 206 3Z3 SSq-v <br /> CONTR. LICENSE 0 rnO FE C-j2�0 12—T3 WN ?i-/ Yq <br /> USE OF BUILDING g�— HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION v C <br /> �t�� T),e rn NGS.( lL(17ii:w>71c�. <br /> 00 s •ed --/ <br /> PLUMBING J WCHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> I _ Toilet A/C—air handling units <br /> A Bathtub Forced air systems <br /> ' Lavatory(wash basin) Gas piping <br /> 1_ Shower Water heater <br /> I Kitchen sink 8 disposal Gas fireplace <br /> I Dishwasher Gas range <br /> I Clothes washer 1 Clothes dryer <br /> Laundry tray = Range hood <br /> Sink(service/bar/mop/etc.) I Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit healer <br /> Bo <br /> Drinking Fountain Boiler <br /> = <br /> I Floor drain :St-- Refrigeration <br /> Grease trap Woodstove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE 18 3103 <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 /> ordinates governing this type of work will be compiled 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 /> Slate Contractors <br /> /Law 18.277 RCW and 296.200 WAC. <br /> it %�Ili)(r � <br /> signature / ontracton thonzed Agent ate <br />