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� <br /> PCRMIT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 6 _ a0_0� <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ,I�O(D - d/� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> - r 3 <br /> LEGAL LOT NO. P!.00K TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> J��tif-� L. d��ri•r `Y2�^ 35'Sr S' / � 3 <br /> TENANT N ' I CONTACT FOR PERMIT PHONE <br /> �a,�.c�S <br /> E 'r[��t�� ! i•.� � �+ �F ��s w ���� G�7i1lr��? S 9-3 89 8� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE#� � ��^Q „ r, � �� � !/ <br /> /LL— D <br /> USE OF BUILDING/ HEAT SOURCE CONTRACT PRICE OF WORK <br /> � � • � .��� _Eleclric �Gas_Other <br /> WORK DESCRIPTIO� �� / / ./ , <br /> Sl �`-I(�, � -�JG ClG l•L.�lu �l- � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air han�ling units <br /> Ba�htub Forced air syslems <br /> � � Lavalory(wash basin) ��7�t� ��M1— Gas piping <br /> _ Shower �� Waterhealer <br /> Kilchen sink&disposal Gas fireplace <br /> Dishw�shcr Gasrange <br /> Clolhos washer Cb�hes dryer <br /> Waler heater Range hood <br /> Sink(scrvicc/bar/mop/elc.) Exhaust(an <br /> Backllow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> �loor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof dr ' s � [� Other <br /> _ ( IOD/f/�I/ll _ <br /> i <br /> � ,s <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify ihat I have read and examined lhis application and know Ihe same to be Uue and correct. All provisions o(laws and <br /> ordinaces goveming this type of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give aulhority lo violale or cancel lhe provision of any other state or local law regu�atinc�consWclion or the peAormance of <br />' construclion.Thal I am aulhorized by the owner of this property to perform lhe work(or which application is made and I comply with the <br /> Slale CoMractors Law 1�.27 RCW an 296.200 WAC. <br /> /? <br /> Sign urc of Ow edContrac or/Aut d Agent ate <br />