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P.RMR APPLICATWN <br />PERMIT APPLICATIVN <br />crtr or eo ea nsenM�rtsenmces <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />•, <br />425-257-d810 —FAX 425-257-8857 — www.everettwa.org %�/U �/�l <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE/ NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />I.D. <br />PER IT # <br />"im <br />A7�2 )Zuc�.��A� <br />G2��izoz3Gi'��G <br />min <br />LEG L T NO. <br />DESC. � L,Pfj I�i <br />X'w <br />BLOCK <br />BLOCK <br />I7 ) C �1 <br />`�_.... <br />TRAC <br />a <br />�/�'1�'L� /TCK➢ <br />OWNER (j2�J'{�Z• � ADDRESS CITY/ZIP 'i�� NE <br />.: ��� <br />^ <br />� <br />TENANT NAME / <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR 10 � ADDRESS � 21P� <br />� (• <br />CONTR. LICENSE M � <br />01 <br />cQ <br />_ <br />USE OF BUILDIN�G1 <br />S� IGN <br />HEAT SOURCE <br />CONTRACT PRICE �OF WORK <br />�) � <br />Electric Gas _Other <br />WORK DESCRIPTION ; ��kl �C� � �� I )�p'OV��,J'�� �h36 t �L,♦)/ � C <br />I <br />,�trds� �qNv /22x�5� r9-N,D /,U�,QrC�'_ <br />T. C <br />OZ <br />� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C —air handling units <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />lchen sink 8 disposal <br />as fireplace <br />!� <br />Di washer <br />range <br />� <br />Cloth washer <br />� <br />Clot dryer <br />_ <br />Laund ay <br />Sink (serve Nar/moplelc.) <br />� Y <br />Range od <br />Exhaust fa �Ci I� �'j'r3:�1/�JeJ> <br />_ <br />BackOow pro nler <br />Heat pump <br />_ <br />Urinal <br />Unil heater <br />Fountain <br />Boiler <br />_Drinking <br />_ <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodstove <br />_ <br />_ <br />Roof drains <br />Other <br />Other i <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby cedtify 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 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 1 am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Staple Contractors Law 16.27 RCW and 296.200 WAC. <br />��C1tiYU 4. � <br />m.„ad.%� <br />�ig�ia-lure O Agent I <br />of er/Contractor/Authorized ate I <br />.gym_. m��.R. <br />