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PEt�2MIT APPLICATION <br /> CITY OF EVERETT PERMIT SEI�VICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> i 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> I <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT p <br /> �(( /1✓�4?'-E/1- �/� Ga�ol�3�j'JDo�{DO � 7 '� ` ' l� �=- <br /> LEGAL LOTNO. BLOCK TRACT <br /> oesc. � �! C,�-p ,Ttn� Hf,�w�tTS Afl0 'fDF.l�r� � � D-� <br /> OWNER � ADDRESS CITY2IP PHONE <br /> -raNE �.�.,,�.� �ru rra,� /8 �r B�,e A✓E £✓�l �is'LS'� 335� <br /> TENANT NAME CONTACT FOR PERtIIT PHONE <br /> k;.� ��-�r7 ��s 35� BSS�� <br /> CONTRACTOR ADDRESS T CITY2IP PHONE <br /> �R�EX/ F��KwveO�••,�� � ��� LAfcE �'L• LA7�- Si�uf�v5 r.Jil'� fdTSS <br /> .ONTR.LICENSE N �Zs-357-8.s� <br /> /LEHrt 6E �!7 S c�s _ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �+n"Je- f° Cw�'� / <br /> c$j,�,>� .�q�,,,,,�.,/ ✓ Electric _Gas_ Olher �`�V� c�-� ��� � <br /> / <br /> WORK DESCRIPTION �1/ <br /> IC�i� ��}( " .�-�w5'iM�L Ca/1S �2AT�F�+'R'�-�� <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> Balhtub � �� �Forced aii syslems <br /> Lavalory(wash hasin) ✓ Gas piping <br /> Shower �, Walerheater --Tka�-ES� <br /> �� Kilchen sinh h disposal Gas(iroplaco <br /> ( ✓ Dishwashcr � Gasrango <br /> ( � Clolhes washer � � Clo�hes dryor <br /> � Walcr healnr -T�K�f-�1 1 �% Range hood <br /> Sink(service/bailmoplctc.) ( � Exnausl fan <br /> Backllow preventer ___ Heat pump <br /> Urinal __ Unil hea�er <br /> Drinkinc� Fountain _ Boiler <br /> Floordrain _ Rofrigr,ralion <br /> Grease trap _ Woodslove <br /> Roof drains _ Other_ <br /> Olher ------ — <br /> I � CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> iI hereby cerilify Ihat I have read and enamined ihis�pplication and know the same to be true and r.orrocL All proeisions of laws and <br /> ordinacr.s c�oveming Ihis type o(work will be complied wilh whelhnr spocified horoin or noL The c�ranling of a permit does nol presume <br /> Iir�give authority to violale c. cancel�he provision of any olher slate or local law re9ulating consiruclion or lhe petiormance of <br /> consiruclion. Thal I am authorized by lhe owner ol lhis propeAy to pedorm Ihe work lor which application is rt�ade and I comply wilh the <br /> � Stote Coniraclors Law 1 .27 RCW and 296200 WAC. <br /> / _— <br /> � z3 z�.� <br /> S� nalure o Ow dCo ctodAuthorized Agent D e �� <br />