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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEL-AR STREET, EVcRETT, WA 98201 <br /> 425-257-8870— FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRES7S PARCEL TAX I.D.# PF�RM/IT(Ml <br /> �� � �t ' �) II �C'1' ��V ('. ('��� �. :� " :; :� � �1 �`J �� ;�`�C '/ ��--� <br /> LEGAL LOTNO. BLOCK 1��[�c TRACT ,� <br /> DESC. ,��-� d� u2 �t• .�7 �I t-U( ( • � .. <br /> OWNtR ADDRESS CITYIZIP PHONE <br /> �>� Il �l"I lt� i�n���,� ;.>nn�c•, i1l�r�vC Lvcr•��t ���701 �,��f^ - ?_��Z <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> —1��i� rk C, <��� c� <>, � 34 • �i2t�Z <br /> CONTRACTOR ��(•<�-VL I �'�)ti7 I Pl C. ADDRES5 CITY2IP PHONE ��Li . �J(nl <br /> l���tl t�l0�� 1 ��u'c' :� i C�u��r�C�C.:, <br /> CONTR.LICENSE M I I �I� (p(�� �` St N l� LV- �7` C U C Il�`� `� r� <-.�� <br /> N��:r��� C, � z �l �C <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Cl����1� I-1 C`�l _Eledric _Gas_Other � �� � SC � ��� <br /> WORK DE3CRIPTION ',� �,i� �� �� - � <br /> �_�� X �Z� l`tr1�� �ac� C�, <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C-air handling units <br /> BathtuD Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water beater <br /> _ Kitchen sink 8 disposal _ Gas fueplace \ / <br /> Dishwasher � _ Gas range �� <br /> Clothes washer � , Ctothes dryer � <br /> Laundry tray Range hood <br /> Sink(service/badmop/elc.) Exhaust(an <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> �rinking Fountain _ Doiler <br /> Floor drain Retrigeration <br /> Grease lrap Woodstove <br /> Rool drains Other _ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> 1 hereby ceiitify Ihat I have read and examined this application and know tha same lo be true and cortect. All provisions ol laws and <br /> ordinaces governing this type of work will be complied wilh whelher spoGfied herein or no!. The granting ai a partnil dces nol presume <br /> to give authonty lo violate or cancet the provision o(any other state or local law regulaling conshuclion or the performancn o( <br /> construdion. That I am authorized by the owner oi lhis property to pedorm the work for which application is made and I cromply with the <br /> State Contractq(s Law 1 �27 RC W an 296200 WAC. _ <br /> / � <br /> —� i, !;..- �'� ,.�� � /�/.-tS � <br /> SgnaWreo OwnedContractodAulhonzedAgent '—� � Dale �L <br />