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3_-�.�y o � <br /> PEf�MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR 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 PARCeL TAX I.D.p E/RM� IT 0 <br /> �. 1,1.�1"�� � C�.S,lid I�tC a�i1. � Z(J .'�l� �JIG- L .�(,�03 ��ooL <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITY2IP PHONE <br /> > ',! i ;. , lrr�� l�� �lC �- � .`�i� % ��l > - ."I'/t� <br /> �Vr'r�' l� l�'l�.11� LL(� I '';t�� I��� nn . I� � . � -� <br /> TENANTryqM CONiACTFORPERMII PHONE <br /> S �� ,�� [ c� t3,��� 5 ���25) �/89 � S9co <br /> CONTRACTOR ADDRESS � CITY2IP PHONE <br /> 1i� .5, -l� 1��� .�1!lr•. S LLC. <br /> CONTR.LICENSEp l ]SCZ r�:�hcN Lc,4.'�/1 IVE � '�� �l <br /> //L�:ilT13L7J�� %l�l i:`1 /if /� laJT{ `)FfL� // �NJS� yS �/".5 %UD <br /> /:. <br /> USE OF BUILDING ' HEAT SOURCE CONTRACT PRICE OF WORK <br /> A ��� �.� ��.�i ��{ �Eleclric _Gas_Olher <br /> WORK DESCRIPTION <br /> � � , <br /> /� i n, cur n �,, { �"if�ll,C[ cl'�� <' � S 7c.� ( � rtc <br /> PLUMBING INECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilot A/C—air handling unils <br /> Balhlub Forcad air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Waterheater <br /> Kllchen sink 8 disposal Gas fireplaco <br /> Dishwasher Gasrange <br /> Clolhes washor Clothes dryor <br /> Waior healer Rangc hood <br /> Sink(service/badmop/olc.) _ Exhaust fan <br /> Backllow preventor _ Haal pump <br /> Urinal Unit heator <br /> Drinking Fount�in _ Boilor <br /> Floor drain _ Relrigeration <br /> Groase Irap _ Woodstove <br /> Rool drains Olher <br /> Olher___ _ _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> I hereby cerilily Ihal I have r�ad and examined Ihis applicalion and know the same to be Irue and correcl. All provisions of laws and <br /> ordinaces governing ihis!yp�of work will be compGed with whether specified herein or not.The granlinc7 of a permit does not presumo <br /> to give authority�o violale or cancel the provislon of any olher stale or loral law regulaling construction or lho pedormance of <br /> conslruction. Thal I am authorized by Ihe ownor ol this property to peAorm the work lor which application is made and I comply with the <br /> State Coniractors Law 1827 RCW and 296.200 WAC. <br /> l 2 �r"�: �, � l) <,�l_. � C.; � .� � - o c. <br /> Signature of OwnedConiractor/Aulhonzed Agenl Date <br />