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c _ <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C�DAR 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 <br /> SITE ADDRESS I PARCEL TAX I.D.# P R Jt <br /> SS D> �LC�r�cCi�f�/✓ G✓/9 :� �/�Z� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNEH �G�yS/ON CDLUS/ditJ ADDRESS CITY/ZIP PHONE <br /> SSU 7 <br /> r�.����Fi� rr,�r �y�eEr- zs�-��o-v2y> <br /> TENANTNAME CONTACTFORPERMIT PHONE L/L�-7Sl/-��Jy <br /> PR��if�oti cu�us�o.� �o N <br /> /-/�/MP/7��s� e•rna� ro��@ s�r�c fiA9ld. <br /> CO TRACTOR AOURESS CITY2IP PHONE <br /> (�-�S �f�.rr���� � uJL/Nc� s0 CJ 1'NSi I��JiN �"/dNRe� JG c'-7 9'/ <br /> CONTR.LICENSE p �J,¢'27L 7 3 O G <br /> �-�'S ���l�C S{�9 3 9 P. (C <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> 3Q�v f</dp _Eleciric�Gas_Olher >� `�y4 �� <br /> WORK DESCRIPTION <br /> �N$T/3'L� �Z, !/ilJi�- //E/�-TE,� S � G-/1=S /7//�//(/G- <br /> �� ��J p T�/�,e rivs T�--7-S <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet NC-air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavalory(wash basin) T Gas piping <br /> Shower Waler healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water healer Range liood <br /> Sink(service/bar/mop/etc.) _ Exhaust lan <br /> Backflow prevenler Heal pump <br /> Urinal 3 Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> I hereby cerilify 1'�al I have read and examined this application and know Ihe same lo be true and correct. All provisions of laws and <br /> ordinaces goveming Ihis type of work will be complied wiU�whelher speciCed herein or noL The granting ol a permit does not presume <br /> lo give aulhorily to violale or cancel ihe provision of any other stale or local law regulaling conslruclion or the performance of <br /> cons�ruction. Thal I am au�liorized by the owner of Ihis property to perfonn Ihe work for which application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 29G200 WAC. <br /> </f/� �,_/�z10-,. //-/��- U !� <br /> SignaWre ot G�v efi r/COnl�ctodAu�horii d Agent Date � <br /> L <br />