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�--- <br /> PERMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVER[TT, 'N� 98201 <br /> 425-257-8810 — FAX 425-257-8857 —wvwv.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� `y `�� <br /> SITE ADDRESS PARCEL TAX I.D.# P MIT# <br /> 3 C'� - �c-� � ,/ . ' <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION ri <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> S��„ H� ,,�..�L C •,�.��T ?"QS' ,@�.kc 1��� � � . <br /> TENANT NAME I CONTACT FOR PERMIT PHONE y1S - 3�Q-�QJ S <br /> �i r I-� S � ^,y� I /'i Y Lf� E-MAILSJ. � / �J i�.(tFC' fi.plt�. '!� <br /> rCONT ACTOR� � C � � ^f ADDRESS � CITYIZIP PHONE <br /> CONTR.LICENSE# <br /> /11 � 'n �, cnc � i)��?�., ln��.:f- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eledric Gas Other <br /> WORK DESCRIPTION -.- � � i�. � ���� ,� , � <br /> - ^ S�TI( S� ' - �.. C <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Tuilet 0./C-air handling units <br /> f3alhlub Forced air syslems <br /> Lavatory(w2sh basin) _ Gas piping <br /> Shower \�'ater healer <br /> Kilchen sinh& disposal _ G s lireplace � <br /> Dishwasher Gas range <br /> Cbthes washer Clothes dryer <br /> Water healer Range hood <br /> � Sink(servicelbar/mop/etc.) _ Exhausl fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease Irap _ Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ccritify Ihat I have read and examined this application and know Ihe same to be lrue and correct. All provisions of laws and <br /> o:dinaces goveming this type of work will be complied with whether speci(ied herein or not.The aranling of a permil does not presume <br /> lo c�ive aulhority to violate or cancel the provision o(any olher state or local law regulating construction or the peAormance o( <br /> conslruclion. Thal I am aulhorized by the owner of lhis property to per(orm the work for which application is made and I comply with lhe <br /> State Conlrar.tors Law 18.27 RCW and 296.20U WAC. <br /> ��-� �.___� /Z — `� - U� <br /> SignaWre o(OwnedContractor/Aulhorized A9enl Dale � <br />