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j 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 /> � PU� �/��- j <br /> APPLICI.TIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> I SITE ADDRESS PARCEL TAX I.D.# PERMIT p <br /> 1 ? 0 -� �?n,�� GC � co3 02o e CO�k07- 00 <br /> LEGAL LOTNO. BLOCK TRA T / / <br /> oes�. - � � (-, u rr,, � � i��' --.�� 1J l-��� <br /> OWNER � - � AD RESS CITYIZIP PHONE <br /> J w ��asco�,v� 312c G�U�/Fr loQk p�� ��,��.l� 9�10� 3�6- Q/6� <br /> TENANTNAME I CONiACTFORPERMIT PHONE <br /> CONTRACTOR 7G `��,y�� AUORESS CITY2IP PHONE <br /> CONTR.LICENSE N <br /> :TGC oN�r+� z?3r.L <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �� S Electric �Gas Othor <br /> WORK DESCRIPTION �. <br /> C�/ /// r�/ % 1 � 1 <br /> J <br /> n> , <br /> �.� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> Toile� A/C–air handling units <br /> Bathlub �_ Forced air systems <br /> � Lavatory(wash 6asin) �� Gas piping <br /> � Shower ��c _ Water heater <br /> � Kilchen sink 8 Cisposal �. Gas fireplace ! <br /> � Dishwasher Gasrange <br /> � Clothes washer T Cbfhes dryer <br /> � Laundry lrey Range hood <br /> _ Sink (serdice/bar/mop/etc.) � Ezhausttan :� <br /> Backflow preventer Heat pump <br /> � Urinal Unil heater <br /> I _ Drinking Founlain Boilor <br /> i _ Floordrain _ Refrigeration <br /> Grease trep Woodstove <br /> i = Roof drains — _ Olher <br /> Other <br /> i — <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> , I hereby ceritify that I have read and ezamined this application and know lhe same to be true and correct. All provisions o(laws and <br /> I, ordinaces goveming this type of work will be complied with whether spocified herein or not. The granting of a permit does nut presume <br /> I to give authoriry to violate or cancel Ihe provision of any other state or local law regulating constructlon or the periormanc6 ot <br /> construction. That I am authorized by ihe owner of Ihis property to perform the work for which application is made and I comply with the <br /> � State Contractors Law 78.27 RCW and 296.200 WAC. <br /> , �,4a.�v�� � " 9' 0 '�t' <br /> i Sig ture o wnen ontracrorlAuthonzed Agent Date ` ( , r � ,� / � <br /> � � / <br /> � - i � � <br />