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___— r <br /> P�RMIT APPLICATIC�N <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 rYl GS �Z-0 /Z <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT q _ <br /> ��c�� I,,, ���� A�.x_ oo� 37s� 3�aoa ,�� �i/ - o, s <br /> LEGAL LOTNO. BLOCK TRACT <br /> oEs� A�v ' 633 p��� - 5 '1.�, o-� I-,o-{-s q�-�0�- Il <br /> OWNER ADDRESS CITY2IP PHONE <br /> rC��I�� ��,,n-�r,., ��7C`�S' i��k�-� �ve F_��e��H- Wf� <br /> �TENANT NAM[ CONTACT FOR PERMIT PHONE <br /> G�„�C« �„��ev� �J �w, C��1k��s �1z5-zr6-�2�f <br /> CONTRACTOR CE���.� �t� ��� IK(( ADDRESS '�ry � z�. CIT/21P PHONE <br /> � n��Etit(l s�a� �b G3�I�i87G <br /> CONTR.LICENSC•N ���-1-. i 1� ``c��4 �� <br /> �� <br /> USE OF BUILDING��f �H�-�i � I HEAT SOURCE CONTRACT PRICE OF WORK <br /> � '���1`��� �Electric Gas Othor � I� � pT �SC <br /> WORKDESCRIPTtON f'P� � " u.�� Na[�� �'Se����e C� K�S ���f �N �VIQ� '� �.L��C Q Ol.1 <br /> �ost-s.,er� a� � <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF I�IXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C-air handling uni�s . . <br /> _ Balhlub � Forcodairsyslems l�•f��tcC N}VS{�KJ <br /> Lavalory(wash basin) _ Gas piping � <br /> Shower W alar hoater <br /> _ Ki�chen sink 8 Aisposal _ Gas fireplace <br /> Disliwashor Gas ranga <br /> Clolhes washcr Clolhes dryer <br /> Wal�r hoater Rango hooA <br /> Sink (servicelbadmoplotc J Exhaust�an <br /> Backflow pr�venlor Hoal pump <br /> Uriral Unil hoala� <br /> Drinkiny Fountain Bollor <br /> Floor drain Rofrigeralion <br /> Grease trap Woodstove <br /> Rool drains O�har __ <br /> Olher _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I heraby ceritity that I have read and examined Qiis application and know the same to bu Irue and correcL All provisions o1 laws and <br /> Iordinaces goveming this lype of work will bo complied wilh whether speciliod hereln or nol Tho granting ol a pormil does nol presumo <br /> to givo authority to violate or cancol lho provision ol any other state or tocal iaw roquleting consWction o�Ihe peAormance of <br /> construclion. That I am authorized by the owne�ol this property to pertorm Ine work(or which applicalion is made and I comply with the <br /> S e Conlracbrs Law 1 7 RCW.and 2�Jfi.200 WAC. <br /> ? �i v � �� Q�� <br /> � [ �� , <br /> i $r �a(ure o(Own F/Co�trac�o/A�nzed Aqont ,�te �� <br /> I ,, �� <br />