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i <br /> PERMI� APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 - <br /> 425-257-8d1 C - FAX 425-257-8857-www.everettwa.org �1FpA�8"�7 <br /> JT <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS � PARCEL TAX I.D.# P I # <br /> Ss��s ��e�� ,-e�� ��� ���3932��G D � -�� ' <br /> � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER I / ADURESS CITY2IP PHONE <br /> 5Co� 7�1i'�'15✓�nc�-{ (p JJ� �c. I��'J(/I�r�• �.x�.�,ol� j,tJ/� <br /> r/ i <br /> TENANT NAME CONTACT FOR PERMIT PHONE �2,C_ 232–3'2gS <br /> (� i � p L <br /> 7 �/�QC��'�.-� �J '�iS i '�v� /'�.e��� lJLI."`�tvh�� 2� E•MAIL <br /> CONTRACTO �DRESS G ITYIZIP� / P ONE <br /> �������) �,�r �Jc�S�� =`�r�n /N`332 !� �� J�E Snc��awSh �r7'J "Z3Z - ✓��J� <br /> CONTR.LICENSE# p I !1 !� � �IZ2?J <br /> /J �iH'I�L�V <br /> USE OF BUILDING HEAT SOURCE CONjRACT PRICE OF WORK <br /> n v , � �[Electric _Gas_Olher ��I�SDOO <br /> WORK DESCRIPTION �x�,,,,�,��� �-- ()�5�A� j-w�, ` S �✓C. ��,c c) ���.5 . <br /> PLUMBING MECHANICAL <br /> NO. 7YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C–air handling units <br /> Bathtub Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Waterheater '�� <br /> Kilchen sink 8 disposal Gas fireplace <br /> _ Dishwasher _ Gasrange � <br /> Clothes washer Clolhes dryer <br /> — Waler heater _ Range hood ��� ,f� ` <br />`�� Sink(service/badmop/elc.) Exhaust fan � ) <br /> _ Backflow prevcnter � ^ Heat pump O � '�T' <br /> _ Urinal �`,�� Unit healer C � <br /> Drinking Founlain _ a �� — �dj � � <br /> Floor drein _ Re(rigeration (v <br /> Grease Irap __ Woodstove �v"p^ <br /> _ Roo(drains _ Olher 1�� `� <br /> _ Other — ������ <br /> — � � <br /> CITY OP EVERETT LOCAL SALES TAX�ODE IS 3105 � <br /> I hereby cerilify lhal I have read and examined Ihis application and know lhe same lo be lrue and correcL All provisions of laws and <br /> ordinaces c�overning ihis lype o(work will be complied�vilh whelher specified herein or noL The granting ot a permil does not presume <br /> to give aulhority lo violale or cancel the provision o(any other stale or lucal law rec7ulaling conslruction or the pedormance of <br /> construction.Thal I am authorized by Ihe owner of this property lo perform the work for which applicalion is made and I comply with the <br /> Slale Contractors Law 18.27 RCW and,'196.200 WAC. <br /> �� .� .` — s/�-/v S <br /> Signat re of OwnedContraclodAulhorized Agenl ate !� <br /> Z <br />