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3 -a�-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 ADORESS PARCEL TAX I.D.# PERMIT k <br /> � ��t �a r�, :�.,, z ?�� , �'>����jF 20 ��n �,i�. z 3o(�G�- u(o �a <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> / �L;,', l;ii,� ;t � . ,/i. �, ll� ilE� s�/ (`�1_J �l/ > > `i`iE <br /> ��-r ,� � /:;l<<!/� 1_LC ' -- - - — _ <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> Si� i,. i,,t r'„��� ��/�15) �/6 i $jnr <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> �IIJ� �C �VL��c/r'i) / 7�c2 Rc�-Hill �vy /UE Sfr t� <br /> i <br /> CONTR.LICENSE 11 <br /> l/��SiTd � `� Ss' Rr, L�nfheN ��"� i5o�� yas) y8'i S; o� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �'i f� �� ,7�� �� .j� � Eleclric _Gas_Othor <br /> WORK DESCRIPT!ON <br /> � l � Ilcii l� Ilrl I � � ��(i('_i C�f C` �.S 71' C�ir'�1. <br /> PLUMBING MECHANICaL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling unils <br /> Bathtub Forr,ed air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower W alor hoater <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gacrango <br /> Clothes washer Clolhes dryor <br /> Walon c�aler Rango hood <br /> Sink (sorvice/bar/mop/etc.) Exhaust fan <br /> Backflow prevonter _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor diain Relrigerat�;n <br /> Groaso lrap _ Woodslovu <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I heroby ceritily tlial t have road and examined fhis applicalion and know lhe same to be lrue and correct. All provisions of laws and <br /> ordinar,es governing lhis lypo of work will bo complied with whelher specified horoin or nol.The granling o(a permit does not presume <br /> lo give authority to violate or cancel Ihe provision ol any olher slato or 1oc21 law regulaling construclion or the perlormance of <br /> construction. Thal I am authorized by Ihe ownor of this property to periorm lhe work lur which application is made and I comply wilh the <br /> Slalc Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> � C j :l- C6 <br /> � i �,�� �. ,,, ! -� .a ��-�� r,� <br /> SignaWro of OwnedContrector/Authonzed Agent ate <br />