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I� PERMIT APPLI�ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � 425-257-8810- FA,X 425-257-8857-www.everettwa.org <br /> � <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT R CREDIT CARDS ARE NOT ACCEPTED <br /> ISITE ADDRESS �VE,�F��7� PARCEL TAX I.D.# PERMIT N � I <br /> Io4�� A�_r��2� wAy,S�-` 3t-T2�,�s�'i 9 "� z�c�4Z3 -��'20-(�� l , ;� � / <br /> I LEGAL LOTNO. BLOCK TRACT <br /> DESC. L+ ���. � I'U <br /> OWNER ADDRESS CITV2IP PMONE <br /> LTr1 �-c EGT- Li, > ,� �l�l u.q SW Y�-/Ea� �(Z5_ ��A--- ��� <br /> i I� 1 " J . � I B� -� A"� --I � "J �a�l <br /> � TENANT NAME CONTACT FOR PERMIT � VHONE <br /> t-A��c-n�cc- FVo/�o�-' �TZ ��r''�-� f1R�'�'� �t��-6�o-E.-k;H � Ug <br /> CONTRACTOR �C'T ��LEG"jL;[�`'�(,`�DDRESS CITV/ZIP PHONE <br /> CONTR UCENSEt � <br /> ' USE OF BUILDING MEAT SOURCE � CONTRACT PRICE OP WORK �. <br /> G�F{- $-G E _Electric �Gas_Other � rj� e>E,c� �'. <br /> WORK DESCRIPTION � <br /> , ��,^�lo �-r�r�z���.- ��=A��J�,v��� p«-� I <br /> PLUMBING MECHANICAL � <br /> NO. TVPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM � <br /> Toilet A/C-air handling units �I <br /> Bathtub Forced air systems �, <br /> Lavatory(wash basin) _ Gas piping <br /> �I _ Shower = Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher _ Gas range <br /> I Clothes washer Clothes dryer <br /> j _ Laundry tray _ Range hood I <br /> Sink(servicelbadmop/etc.) � _ Exhaustfan . , <br /> i Backflow preventer _ Heat pump <br /> �� Unnal _ Unit heater <br /> �I _ Dnnking Fountam � _ Boiler <br /> � Floordram _ RehigeratMn <br /> Grease trap _ Woodsrove ' <br /> � Roof drains Other <br /> Other — <br /> — i <br /> � — <br /> I CITY OF EVERETT LOCA4 SALES TAX CODE IS 3106 <br /> I� I hereby ceritiry that I have read and examined this applicatian and know the same to be true and wrtect. All provisions of laws and <br /> �i ordinaces governing tnis type ot work will be complied with whether specified herein or not.The granting of a permit tices not presume - <br /> Iro give authority to violate or cancel the provision of any other state or local law regulating wnstrudion or the perfortnance of <br /> construction 7 hat I am authorized by the owner o�this propeRy to perfortn the woAc for which applicalion is made and I comply with the <br /> I State Contractors Law 1827 RCW and 296200 WAC. <br /> I �-7 r � �fie r��'�i. e l��o j � <br /> '� Signature of edContractor/Authonzed Agent Date �I <br /> I <br />