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( <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PEFtMIT SERVICES <br /> 3200 I.EDAR STREET, EVERE'T'f, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM . ��Q�,} <br /> SITE� ADURESS PARCEL TAX I.D.# PERMIT# <br /> ..`.�> 0� �'VF/:— G�•li:�A/ 4I/'�c ' — <br /> LEGAL LOTNO. LOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> . <br /> � <br /> TENANT NAME " CONTACT FOR PERMIi PHONE , <br /> �/�l?�.r- P�'a,�S f C i=rr_ /j•:,aT.�^f. I I�v • I(. J�`io�✓ 3G n_SHJ�l�-6 L- �� <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> /<<Ki. t�2i r�i'� G���7n..r�7c.,�� ��i� S�✓l-c_ /��F /YJ/J�sy�yc��c �Lv - G S l- O/o �Tyc <br /> CONTR.LICENSE#" �� �� �� . 'G 2Q.:, <br /> , 7 SCc2tQ; �GY C SVCS — — <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �p sr:✓W? (/�r2 Ll/'��i N ///�� <br /> � � p�r ! _Eleclric _Gas_Other <br /> ��" ✓� I-.G - <br /> WORK.DESCRIPTION .._-. - <br /> � ;'� ��% <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ NC-air handling units <br /> Balhlub _ Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Wafer healer <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas�ange <br /> Clolhes washer _ Clothes dryer <br /> Walerheater _ Rangehood <br /> Sink(sorvice/bar/mop/elcJ _ Exhaust i�n <br /> Back(low prevenler _ Heal pump <br /> Urinal _ Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain _ Retrigeralion <br /> Grease lrep _ Woodstove <br /> Roof drains _ Olher <br /> Other — — <br /> CITY OF EVERETT LOCAL SA!ES TAX CO�c IS 3105 <br /> I hereby cerility lhat I have read and examined this application and know the same lo be true and correcL All provisions of laws and <br /> ordinaces�overning lhis rype of work will be complied with whelher specified herein or noL The granting o(a permil does nol presume <br /> to c�ive aulhority to violale or cancel Ihe provision of any olher slate or local law regulaling construction ur lhe pedormance of <br /> r.onstruction.That I am aulhorized 6y lhe owner of lhis property to per(orm the work for which application is n�ade and I wmply with the <br /> Stale Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> l,�✓/� - % -.r 7-�_" � <br /> Signalure of OwnOrl onlractor/Aulhonzed Agent Date //L <br />