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3 -�� -o <br /> PEKMIT 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 /P�ERNJIT# � <br /> Z L..`cS1 Ct�S,hd �cl � l�il�it � 2� - 3 /Y `!/(n 'L 1 i �1'Z� ' � <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITVIZIP PHONE <br /> 1=1�f�lt'f! 1�'lI.��J l_�.(� � :"'. �ii/lri �5�: � ��'i�ivi � l-� l ��l � ���� �'il .. � /_�� :. . .� ' �_f . <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> .S6c � '/ l � <br /> hc"�J ��,�R�t,j Y�`/ �7�J`!- S)ai� <br /> ..w <br /> CONTRACTOR r AODRESS CITYIZIP PHONE <br /> �il J� �! �')i,� l�/FrS LCL <br /> , -r��z i3r�l�i� e.;�,y ;Ue ,sr�. v <br /> CONTR.LICENSE N <br /> /N5iTR3� °I55 �4 l�r-Ili: i/ c.:�,y /���i y15) yb`> -5`90,:+ <br /> USE OF BUILDING HEAT SOURCE ( CONTRACT PRICE OF WORK <br /> �)���, �a„��„ � � X Electric _Gas_Olher <br /> WORK DESCRIPTION <br /> /\< i >� C :C. �.�"1 r�� Y f�' ��:. C.i. , C i L r� } "/C ����Ji_ ' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilut A/C—air handling units <br /> Ba�h�ub Forced air sysloms <br /> Lavatory(wash basin) _ Gas piping <br /> Shower . Wa�er heater <br /> Kilchen sink 8 disposal _ Gas fireplaco <br /> Dishwasher Gasrange <br /> Clolhes washor Clolhos dryor <br /> Wator heater Range hood <br /> Sink(service/bar/moplel�.) _ Exhausl fan <br /> BackOow prevonter _ Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain _ 6oiler <br /> Floor drain Relrigeration <br /> Grease trap _ Woodstove <br /> Rool drains Other <br /> Olhor <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS�105 <br /> I here�y corilify that I have read and examinr.d this application and know tho same lo be true and correct. All provisions ol laws and <br /> ordinaces goveming Ihis typo ol work will bo complied with whether spaci(ied horoin or nol.The granling of a permil does nol presume <br /> to c�ive authority to violale or cancel Ihe provision of any olher state or lor.al law regulating wnslruction or lhe periorm2nce of <br /> construction. That I am autnorized by th�ownor o(ihis property to perlorm ihe work for which applicalion Is made anA I compty wilh Ihe <br /> Slale Coniractors Law 1827 RCW and 296.200 WAC. <br /> / .,` C � -� / - c^G, <br /> / ( .'( sLr>t � i � � <br /> ;�ynature ol OwnodContractor/Authorized Agent Date <br /> �._._ _._ . . .._ ___ ...---_..-----�--------- <br />