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-0 3 -D(o <br /> P�RMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-25"� 9857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS f-J PARCEL TAX I.D.# PERMIT N / <br /> '? LiJi"�i L,�.'o� ,��. i<r��. < ( 1. ;�J� I?�C�i'� ! UI �I00 �!'�� '- l�� / <br /> LEC-. LOT k0. BLOCK TRACT <br /> OEfiC. <br /> ONNER ADDRESS CITY2IP PHONE <br /> � ✓< ff � �'/u �l� LLC J5'L71��n.tSf-.� Kc�.�luc. NI �)6J3•l <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> ��i „��.) P':i`J:� �L�'c) Zz`� � ���'� �� <br /> CONTRACTOR ����, ��^ �ji� ,�/, /.-, � ADORESS CITYIZIP PHONE <br /> i7��ZZ. /�.�ihr /ll�;f /�-'E�.� Et'l� <br /> CONTR.LICENSE p <br /> �n�s � Tl��- '15�� i��, i'c, h�i� c��.q `)sci� ��f.�5�'1;t9 S�io�> <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric 3as Othor <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C-air handling unils <br /> Dalhlub Forced eir syslems <br /> Lavalory (wash basin) Gas plping <br /> Shower Wator haator <br /> Ki�clien sink d dis{�osal Gas fireplace <br /> Dishwasher Gas range <br /> Clo�hes washer Clo�hes dryer <br /> Watcn c�atcr Range hood <br /> SinY.(service/bar/mop/etc.) Exhausl fan <br /> Backflow preventer Heat pump <br /> Urinal Unll healor <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Greaso lrap Woodstove <br /> Roof drains Olher <br /> Other <br /> CI fV OF EVERETT LOCAL SALES TA%COOE IS 7105 <br /> I hereby cerilify thal I have read and ezamined this applicalion and know lhe same lo bo true and correct. All provisions of laws and <br /> ordinaces governinc�Ihis typA ol work will be complied with whether specified horein or not.The granting ot a permit does not presume <br /> lo give aulhority lo violate or cancel tho provision ol any olher stale or local law regulaling constructinn or lhe peAormance of <br /> construction.That I am authorized by the owner of tliis property to per(orm lhe work for which application Is mado and I comply with Ihe <br /> State Contractors Law 18.27 RCW and 29Fi.200 WAC. <br /> Signalure uf OwnedConlractodAulhorized Agen� ate <br />