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P�RMIT AP�LICATIGrI <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org i <br /> �( 5��`I ",3 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS A E NOT ACCEPTED <br /> S}TE AD ESS PARCEL TAX I.D.# �PERMIT# <br /> l 102� �RnW1�1�Y �9�bz33"io��oo/a�438z�i ! g o��i -oQ3 <br /> LEGA LOTNO. BIOCK TRA <br /> DESC. ��O ^�.(Fa 3'�ci � ��T o� Eu'vezil' 1�luisro,v t�. .. <br /> OWNER ADDRESS r CITYlZIPn rf PHONE <br /> �l�W@'-� J��2C,5 � �fJ`C� �t Z1 �Z`1=1 ��G IYG 17CUG�w—. �G'i L'6Z ,� <br /> TENANT NAME CONTACT FOR PERMIT PHON <br /> � l,W��-lt�rz_. 2�'i3. 9'zZ,b�r5 <br /> CONTRACTOR � � �� 'TW� ADDRESS �� CITY2IP PHONE <br /> � L'.����{^�vE �, C' �y'-,� ,°�Z �6�15 <br /> CONTR.LICENSE# �� 0 ��E <br /> �.�-(�-�Yf-Z� R-� <br /> USE OF BUILDING ^�l� HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �`r;*�l�-S �� � �Electric Gas Olher ZB�� <br /> WORK DESCRIPTION ����`1 , I�,� '��w���� S��2V lLes <br /> \ 14 <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE C.`:ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 1 Toilet A/C—air handling unils <br /> Bathlub Forced air syslems <br /> 'L Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes v.asher Clolhes dryer <br /> Laundry lray _ Range hood <br /> 2 Sink(service/bar/mop/etc.) _ Exhausl fan <br /> 3 BackOow prevenler _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> I 2 Floor dreir, _ Re(rigeration <br /> Grease trap _ Woodslovo <br /> L Roof drai s _ Olher <br /> � Other U 11'YL. a<<-- _ <br /> �_ o� S rnf _ <br /> CITY OF EVERETT I.00AL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined lhis applicalion and know the same to be trua and correcL All provisions of laws and <br /> ordinaces governing Ihis lype of work will ba complied with whether specifi�d herein or not.The granting of a permil does not presume <br /> lo give aulhority lo violale or cancel ihe provision of any other slalo or local law regulating cocstruction or tho pertormance of <br /> construciion.That I am authorized by the owner of this property to perform lhe work for which applicalion is made and I comply wilh lhe <br /> St ntractors Law 18.27 RCW and 296200 WAC. <br /> ��r.��.–J �- �`( 2°� — <br /> Signature of OwnedContreclor/Aulhonzed Agenl Date <br />