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P�RMIT APPLICATI(�N / <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —vn�vw.everettwa.org <br /> APPLICATIONS ARE ACCEPI ED FROM 8 AM TO 4 PM <br /> SITE ADDRESS � PARCEL TA7(I.D.11 PERMIT# <br /> � v.�, � Lu�� � li tir_t�� �� /—`C�O�I /�i0��/D/°/�� � ��J(OG7 ' �S�-+ <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS CITY2IP PHONE <br /> � <br /> � /� ��/ccl�.� !_!_C �3r3 �an:. .5<.� /C�ii �un � �6 /3tF <br /> E'�r� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> �JLC /)!�C' ��f��.J �1� t�� 1��1" 70'36 <br /> CONTRACTOR ADDRESS C17�21P PHONE <br /> �/1c5���� �t[�/n'i i .i <br /> /7St� i'��,1,��� �a�, �;E-, 5�� D <br /> CONTR.LICENSEp ,. > r _ � �j�i�hr 1/ ,(,�/� `/S'dl! �t�/,�,5) yc`3'`� S50(> <br /> //L�,iT(.�/_ /,,`�n(i <br /> USE OF BUILDING � — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric _Gas_Olher <br /> WORK DESCRII'TION <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NU. TYPE OF FIXTURE OR ITEM <br /> Toilel _ NC—air handling units <br /> Bathtu6 _ Forced air systems <br /> Lava�ory(wash basin) _ Gas piping <br /> Shower _ Watorhealar <br /> Kilchen sink 8 disposal _ Gas firoplaco <br /> Dishwasher _ Gasrango <br /> Clothos washor _ Clothes dr�or <br /> Wa�or hoalor __ Range hood <br /> Sink(sorvicr./bar/moplMc.) _ Exhausl lan <br /> Backllow provenlcr _ Heal pump <br /> Urinal _ Unit haalar <br /> Drinking Founlain _ Boilar <br /> Floor drain _ Relrigeralion <br /> Groase lrap _ W�dslove <br /> Rool drains _ O�hor <br /> Olher -- -- <br /> CITY OF EVERETT LOCAL SALES TAX CODE�S 3105 <br /> I hereby cerilify Ihat I have read and examined Ihis application and know the same to be lrue and corre�t. All provlsians of laws and <br /> ordinaces governing lhis lype ol wurk will be compliod wi�h wholher specifiad herein or nol.Tho gran�ing ol a permil does nol presume <br /> to give authority lo violate or r,ancel Ihe provision o(any othor stalu or Iocal law regulat6ig conslruction or the performance of <br /> construclion.Thal I am authorized by Ihe owner of Ihis property to perlorm Ihe work for which applicalion is mado and I compty wllh the <br /> Stale ConUneUrs Law 1�27 R and 296.200 WAC. <br /> � ' `7-�D/ <br /> S Date <br /> SignaWre of O nedConlra a �Aulhorized Agent <br />