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�— <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I �-3.� —a 6 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM D � b d I �I� <br /> SITE AODRESS PARCEL TAX I.D.# PERMIT# <br /> ��lD�n l�� s y a ��oa 90D l�vo� -o�H <br /> LEGAL LOTNO. BLO K TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE yaS _ <br /> �LC � -S�iwru.�s� C�r,u��, Pa 6�� �i�3 �ue�cf 9�'zv3 ���9�0�0 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> ��� <br /> CONTRACTOR 11Un/�En,•,l ADDRE55 CITY2IP PHON�Uv_L'��_a�� <br /> /✓ (-h L(:�' 7 <br /> CONTR.LICENSEp �Cl����� ILI`��GA �5�31 C'��. �CKL� , �JR, V ��1lrt�111l� �vD�S <br /> 7U I J u'l. <br /> USE OF BUILDING — HEAT SOURCE ( CONTRACT PRICE OF WORK <br /> Eleclric _Gas Other <br /> WORKDESCRIPTION �,����0`�S� ��`(��cv�� -�p �l�l,� ll� P��-l� L� <br /> ��e <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> Waler healer Rance hood <br /> Sink(service/barlmop/elc.) Exhaust fan <br /> Backflow prevenler Heal pump <br /> Urinal Unit healer <br /> Drinkinc� Founlain Boiler <br /> Floor drain Refrigeretion <br /> Groasc lrap Woodslove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity lhat 1 h;ave read and examined this application and know the same to be true and correcl. Ail provisions of laws and <br /> ordinaces 9ovemine�this type of work will be complied with whether specified herein or noL The granling of a permit does not presume <br /> lo give authority ic violate or cancel lhe provision of any olher slale or local law regulating consWclion or lhe pedormance of <br /> consiruction.That I am authorized by Ihe owner of this property lo per(orm the work for which app�ication is made and I compiy wilh the <br /> j Stale Co�tractors Law 18.2 and 296.200 WAC. <br /> ��lv��� ��r--� ��3�-�o <br /> Signature o(�' /Contr�ctodAulhorized Agent Date <br />