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PE�tMIT APPLICATIO�� <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 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PE T M _ <br /> Hbo3 LGFRAYE `�8203 Gb�l�-c.vo-oo;t-o� J - <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. � Uvv Wes� R�d Net 1t�s <br /> OWNER ADORESS CITY2IP PHONE <br /> Cctrw�e.v� I'V1 Ha�- ��s (oS�o Dlywpt���-, Frereit `�8�o� yass�3�sy <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �i►v� }{arr�s ��ve H4�ri5 Cel1 ;253 ^ �`t1 • 8157 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE N �rn/y j � <br /> l 4�«� <br /> USE OF BUILDING HEAT SOURCE CON CT PRICE OF WORK <br /> J11'�1� ���<� ��//�n/J I _ElecMc �s_Olher '� N 1� �— <br /> � � !�— � <br /> WORK DESCRIPTION <br /> �,,�Idi„ � Walls cu,dl o�e extec-�o,- doo� � oldl a�a�,2 � corerl' <br /> �{ara ��h-� aN u� hek-���2 Sinra are« , f}Iso� rep�a�e olc2 srn0.11 <br /> U a�, ni-i'o ur v� ecc}e� S�Ur'A <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. 7YPE OF FI%TURE OR�TEM <br /> i <br /> Toilet ' A/C—alr handling units <br /> Bathtub Forced air syslems <br /> � �Lavatory(wash basin) Gas piping <br /> $hower Water heater <br /> � K�tchen sink 8 disposal Gas Tireplace <br /> O Dishwasher Gas renge <br /> __[_ Clolhes washer ,�� � C u Y�C�vC��� Clothes dryer <br /> �, Laundry tray Range hood G��� <br /> Q Sink(service/badmop/etc.) eX� S"t��Q � Exhaust fan � �G�� <br /> Backflow preventer X Heat pump <br /> I U Urinal \ U _ Unit heater <br /> � Dnnking ��ountain Boiler <br /> � _p Floordrain Refrigeretion <br /> � U Grease trap Woodstove <br /> �. Roof dralns ome� GIoPCI Fi�YP PIaCB <br /> Other '"J �a5 Fiarnal�e <br /> '� CITY OF EVERETT LOCAL SAL S TAX CODE 19 7105 <br /> I hereby centi'ry that I have read and examined this appllcaUon and know the same to be true and conect. All provisions of laws end <br /> orainaces governing this rype of work will be complied wdh whether specified herein or noL The granNng of a pertnil does not presume <br /> � to give authonty to violate or cancel the provision o(any olher state or local law regulatlng consWction ar the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which applicatlon ia made and I comply with the <br /> � Stato C tr pr Law 18.27 RCW and 296.200 WAC. <br /> t �ti�,. 9 ra/y <br /> ! 'S g t o wnerr ontracronAuthonzed Agent �'—b�te <br /> I �� <br />