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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 -www.everettwa.org G�`6 _(J(� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �/„�� �/�S� <br /> � �ta� �� <br /> SITE ADDRESS PARCEL TAX I.D,p PERMIT# <br /> �`b Z�b CaL�1•l Wp07 O 1 Z4�p ' - 2 - O IZ. �7V Ob- 00� � <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �OPu� � f�ox I1o7 �.�1�IztTC 1,�}p. 4�s '1g '� �1�.-�b <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> C�u�����Z_ w�Q�c���i 1�rci(a I�FfOI�' S05 �115 Z� Z— <br /> CONTRACTOR ���L��L (��,.y.�M ADDRE55 CITY2IP PHONE <br /> �G Zy',c� «ii" aU� Na �.A z�o C'���na�D ��S <br /> CONTR.LICENSE# ���5 �aZ��1 `�ZS g`�� ��Z/ <br /> c-��,t C-�iL=1-IG-�-' bf�1 `��GZ C'�1-� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> FJ �F(, _Electric _Gas_Olher �I Gj �� <br /> � <br /> WORK DESCRIPTION <br /> Ir-.�'�'-��1. 1�ti?1"CNtJa`� bN l'ti7���7 �'ILl'Ty �l`� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR�TEM NO. TYPE OF FIXTURE OR ITEM <br /> Toiiet A/C—air handling unils <br /> Bathlub Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink& disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Cfolhes dryer <br /> Water healor Range hood <br /> Sink (service/badmop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heal pump <br /> Urinal Unil heater <br /> Drinkinc� Fountain _ Baiier <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify thal I have read and examined this application and kno�v lhe same lo be true and correcL All provisions ot laws and <br /> ordinaces goveminc� lhis type o(work will bo complied wilh whether specified herein or noL Th�granting o(a permil�ioes nol presume <br /> lo givo aulhorily lo violale or cancel lho provision of 2ny other slate or!ocal law regulating consWclion or lho peAormance of <br /> construction.Thal I am authorized by the owner o(Ihis properly lo perform lhe work lor which appiicalion is made and I comply with lhe <br /> Slale Contractors Law 1 .27 RCW and 296.200 WAC. <br /> : <br /> � .y <br /> Signaturc ol Ow e C6nVactor/Aulhorized Agenl Date I <br /> Yz �� <br />