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kt-)--)e?" <br /> r- <br /> - <br /> PERMIT APPLICATION s`' o‘, <br /> CITY OF EVERETT PERMIT SERVICES '7, <br /> 3200 CEDAR STREET, EVERETT, WA 98201 /- <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org _ Div <br /> )�:G, r— _j7APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -7..,0L,,__ 0 <br /> __,-SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> • - ,p i. • - • - 0CD38(�QQ f k ; , :� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC.Jr <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> t-t V.N ki 6 OrCbt C -AriNaCA 1 EJE,t,� t to z(0l(0,f11. - - --.),2, <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �� `` � p�,p a <br /> ClP 1:::5ir„... .-... ., -�-v rvt IPC),QCV ZVV - O O 0$CONTRAR --k---\6,p________,0,)J ADDRESS CITY/ZIP PHONE <br /> j <br /> CONTR.LICENSE-1F-. "- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> U.),v-e.. _s bk\ �? S Electric 1 � t CCanCSC <br /> ectc Gas Other <br /> WORK DESCRIPTION <br /> Pty e_ c e_- _,Azts 0.4ok, B uidh.iy;g pe- Use uOs <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR!TEM <br /> Toilet NC-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) <br /> Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood l <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal _ Unit heater I <br /> Drinking Fountain — Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contractors Law 18.27 ROW and 296.200 WAC. <br /> Signature of Owner/Contractor/Authorized Agent Date 1/z__-, <br />