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� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS �(J' j �J �j�� 7�{, Jf -, PARCEL TAX I.D. # P RMIT # <br />�� V ECk:' fc- %T G'S �} t� �L � � % � � �/' , G �-c�' J <br />LEGAL LOTNO. BLOCK TRACT <br />DESC. ��_I �. I JLi� �)G�C- ..�%�� �I LJ <br />OWNER �ti�,� �( .�r?����;,7�-F7Lk'{�;L. G' �"� ADDRESS � L��jL� CITY/ZIP PHONE � �i� c� <br />~ ._,3LGL'S <br />� ����� _-� �.-��� ,,c,�� � � , . ���n n�a� 5��--� ��t� :��=�� ti�� <br />��i �� �' �z <br />TENANT NAME CONTACT FOR PERMIT Ui1tJ/i�'L„S Cf �?>� f— PHONE $�.S L� 7l)Ly IU� <br />�L C� ��/2t` G��- /����'�',� �f f-�x:�;'�-- , ..__--- ;(..I � v <br />�� ������ �7� i�� /�'.����ri1 - ,���fe� �,l � �k��(� �-��:. l��✓n�.. <br />CONTRACTOR % J7 j'� ADDRESS CITY/ZIP PHONE <br />C.J�/ <br />CONTR. LICENSE # <br />USE OF BUILDING <br />L.'�Miyel�;a ( <br />WORK DESCRIPTION <br />J�-�'- i�i u l ��"� u-'� , <br />HEAT SOURCE <br />_ Electric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />; "�i�� /S`� ;r�r ., - <br />P�i �' �i.J ��C �! � ti-l� /� �' �% J� GL 2f'1 L i �`'� 1,2,�,? ��.`� <br />PLUMBING <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />I�I[y_\� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstave <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify 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 RCW and 296.200 WAC. <br />� Z 'L/ <br />`� ��,� C�`�a.� �'� ,� i �:�:::�z��r�l f-���' / �C�-f�- <br />re of Owner/Contract ,r/Authorized A en Date <br />�. 9 � ( /� j <br />� �� <br />