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PE.lMIT APPLICATIO�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9820'i <br /> 425-257-8810 — FAX 425-257-8d57—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT <br /> �( 3 3 a � f3Ro.4o�u.�y � �(l - � <br /> LEGAI LOT NO. BLOCN 1'RACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �L�7�-I Aa_,�' �1�� �' <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> c��M p��� I-��a�n-� �/!� <br /> CONTRACTOR /JiE.�� �I,.�u�C,��� ADDRES � CITY2IP PHONE <br /> C� LJ� 5��o/-.5���°Ln/C �Q�,sv�ccr 36o-6S/-/?�.S— <br /> CONTR.LICENSE# �E,y,,�c rq9�,)}G 9��27b <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Elecinc Gas Olher ��� � <br /> WORKDESCRIPTION IXISUC_�-�-E 'T�-hL 5���' �'�dC�j �(GN�7T (�Jf�CJG���.�� <br /> ��o �'-i-r� . �I �u� �,�,,at{ - �-isnN� ' <br /> I�/oxl �,:.,)=cuMi.v t, <br /> � I�� � —� o �3 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURt�7R ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/6ar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Unnal Unit heater <br /> _ Drinking Fountain Boiler I <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Olher <br /> � <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS J105 <br /> I herehy centify that I have read and examined this application and know the same to be true and correct. All provisions of laws anA <br /> ordinaces governing this type o(work will be complied with whether specified herein or noL The granting of a permit does not presume <br /> Ito give authonty to violate or cancel the provisi a other state or local law regulating consWctioc or the performance of <br /> construction. That I am authorized by ihe er of this roperty to perform ihe wor for whicY 3pplication is made and I comply .vith the <br /> Slate Contractors Law 7P.27 RCW an 6.200 W <br /> � 9 zo as� <br /> Signatvre of Owner/ContractonAuthorized Agent Date � <br /> t� <br /> �_ <br />���.�-_ <br />