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; <br /> S�O — �� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMlT 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 3...�p -.-(� ,G <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT# <br /> �.��o � � ✓��� 0055���.`dnOacO ,���cz-<:;�� <br /> LEGA LOTNO. BLOCK TRhCT <br /> DESC. <br /> OWNER AUDRESS CITY2IP PHONE <br /> yt.;lclrnkl a.�.�eve�u� W�w� �{za-(�3�-1`tZ5 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �e'a'' ,��g�3,�1 �e,,,,,t j�npe,�r a�o-�-'�'$8 <br /> 1 Yl 4 X[l <br /> CONTRACTOR `�""�� ADORESS CITYIZIP PNONE <br /> CONTR.LICENSE M <br /> USE OF BUILDING NEAT SOURCE I CONTRACT PRICE OF WOFiK <br /> ���� �� �� I �„ElecMc _Gas_Other � q��wro _ <br /> N-f�nE'� <br /> WORK D'ES" C�RIPTION ^ �( , <br /> WL�t, Mn.�S f�'� �^��p� `�pv IAhJ��SS 111��ev�P� <br /> PLUMBING MECHANICAL <br /> NO. TYFE OF FI%TURE OR ITEM N0. TYPE OF FI%TURE OR ITEtA <br /> Toilet _ NC–air handling units <br /> Bathwb _ Forced air systems <br /> Lavalory(wash basin) _ Gas pipin� <br /> Shower _ Water healer <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Clothes dryer <br /> Laundrytray _ Rangehood <br /> Sink(servicePoadmop/elc.) _ Exhausl tan <br /> Backflowprevenler _ Heatpump <br /> Urinal _ Unit heater <br /> _ Drinking Fountain _ Boiler <br /> Floordrain _ Refrigeralion <br /> Grease Vap Woodstov,: <br /> Roof drains _ Olher� <br /> Olher�� — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby centify that I have read and examined this applicalion and know lhe samo lo bo lrue and correct. All provisions of laws end <br /> orclineces goveming this type of work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other stale or local law regulating construction or the performance of <br /> conslruction.7hat I am authorized by the owner of this property lo peAorm lhe work for which application is made and I comply with the <br /> Stato Contractors Law 18.27 RCW and 296.200 WAC. <br /> Sgnature o O�medContractodAuthonzed gent Date y` <br />