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' � � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES j <br /> 3200 CEDAR STREET. EVERETT, WA 98201 i <br /> � 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � _,�Jc � 7 <br /> SITE ADDRESS PARCEL TAX�.D.R ��RMI�� ` _ �,J� <br /> 1715 �rcw�c�w4. �Oy � 3 _ 3(�0 / d <br /> LEGAI LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> S'�e�4� �nc Ilal �a4'"/�ve f3��e�we. lua5�y55-G5a3 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �--�ewc�� #CY-I�y R�,cK v,1���c� (25�87a-�aaa <br /> CqNTRACTOR ADDRESS CITYIZIP PHOME <br /> Nfc,her GonSi��+�c�n '�nc. ?855 S �'" st ker� v,�3a L�53)37a- 7a�a <br /> CONTR.UCENSE�I �,^���x��'��� <br /> K <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other Y�7�� <br /> YYURKDESCRIPTION {- �E.IcX���C f{eac_� �c� �¢W ��n�-1��' W�.l�s h S�rF�+s <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling umts <br /> 8athtub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposai _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Ctothes dryer <br /> Laundry lray _ Range hood <br /> Sink(service/bar/mop/elc.) _ Ezha�stfan <br /> BackFlow preventer _ Heat pump <br /> Urinal Unil healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roofdrains Other <br /> Other � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 1705 <br /> I hereby ceritify that 1 have read and examined this application and know the same to be true and correcl. All provisions of laws and <br /> ordinaces gov�ming this type o�work wtll be comphed with whether specified herein or not The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction o�the periornance of <br /> construction. That I em authorized by lhe owner of thls property to perform the work for which apPlication is made and I comply with the <br /> State Contractors Law 1827 RCW and 296200 WAC. <br /> �I"�f�✓' ,( �1X�'�fwC <br /> Signature of OwnerlContracror/Aut onzed Agent Date �/ <br /> Z <br />