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PEaMIT APPLICAT'�ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 - www.everettv+a.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM G� _/v -� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> I� I"-7 i�j-t� y`("''p�-�f� OD4��423DGb I o O ����Z <br /> LEGAL LOT NO. BLOCK TRACT OR SUBOIVISION# <br /> DES�:. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �avit�t�cc� ��`a-�.s�vcc�.� 132i ca_i�-,',av�. .�v�gtr 4�r�•2al•403'� <br /> �82�ro <br /> TENANT NAME CONTACT FOR PERMIT PHONE Q��S"j• 2rj�! •DB�oQ� <br /> 'K'�O�f tt�.t10E 'R��6hl/�(.i <br /> ME271G�.1� Gw-rT�-� '.�Y�Z'�`'�- ��Y�� ZI�Y�-O{�' E-MAIL dGYlfl�-{�(l�'131'Gl�.c.o <br /> CONTRACTOR A JRESS CITYIZIP PHONE <br /> Mo�TC--NG_OCL 1�1-'�1% t-IE 2��`'� 'pL .p���v�1� 42.5• 8�'JS• °JDO p <br /> CONTP.. LICENSE# <br /> lvCAMOt7L � 1�I�t�(<a �J800"7 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> GA(-1GEYL CEt-LCE7Z GL-It-1lG <br /> •,�� �.�����..{ _Electric �Gas_Other �`�'8�� ��• �d <br /> WORK DESCRIPTION <br /> -t�Np.i-Cr i�'i�oVElv�c-�tt" �ZCi1�t�o�-.L '-c�-IC- ��ccrit"tt�(G 4�"� �LGY1Fz �!--��- <br /> G�PG� "t"� �s-lGll'F�(�C P' �fL-zJ�. lF A-r�MlS�I H i'l4�l�`Cl� b�IGE �AG�. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF Fli(TURE OR ITEM <br /> Toilel A/C-air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas pipiny <br /> Shower Waler h�aler <br /> _ Kilchen sink&disposal _ Gas(ireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> Waler heater Ranye hood <br /> Sink (service/bar/mop/etc.) Exhausl fan <br /> Back(low prevenler Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> Ploor drain Re(rigeralion <br /> Grease lrap Woodstove <br /> Foof drains Olher <br /> Other <br /> CITY OF EVEREiT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know lhe same lo be lrue and wrrecl. All provisions o(laws and <br /> ordinares governing lhis fype o(work will be complied with whelher speci(ied herein or noL The grantiny of a pennit does not presume <br /> to give aulhority to violate or cancel Ihe provision of any other stale or local law re9ulating conslruclion or the performance o( <br /> construction.That I am aulhorized by the owner of this property lo perform lhe work(or which application is made and I comply wilh ihe <br /> State Conlractors Law 18.27 RCW and 29 .200 WAC. <br /> B-�-D� <br /> ignature o(O nedContr io�i ed Agent Dale / <br /> � L <br />