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PE.tMIT APPLICATIO. . � <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 <br /> SITE ADDRESS �'�0��=�L - �A�� PARCEL TAX I.D.q PERMIT# <br /> �" I I �c A� w A C> >' (0 0U /Dv 1 Jd-1-C2� �o <br /> LEGA LOT NO. BLOCK TRACT OR SU9DIVISION N <br />� DESC. ! �' IJ-C-1C [�,�lc;r-� ��, v [_' /��,�7 <br /> OWNER ADDRESS CITY/ZIP PHONE •, <br /> '4'zS•5d�-�C�C)�� <br /> �,a r� � ��c�s� 2325 ����'Qu� �C .-�1'�ktTT, �sos <br /> TENANT NAME CONTACT FOR PERMIT PHONE L.Ly _�,.—� � _(�)�O <br /> /'� T <br /> �1 � � �A� � I C/ L�2 S C-� E•MAIL <br /> N ICf+ �� DR S L`IT47� <br /> i CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORI( <br /> ElecUic _Gas_Other O� <br /> ('���N�► ,��� n r. r �� c — �3C�� - <br /> WORK DESCRIPTIONS�J �(�1,(,� �—J� �/� ( LS O�J c/�IS� ��� N�NDI �� <br /> I�/-1 M 1? <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Dathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Showrr Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink (service/badmop/etc.) Exhaust fan <br /> Backfiow prevenler Heat pump <br />, _I Urinal _ Unil heater <br /> _ Drinking 1=oun�ain _ Doiler <br />' Floor drain Refrigeration <br /> Grease trap _ WooAstove <br /> Rrof drains Other <br /> � Other <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS�105 <br /> I hereby cer!ify thal� have read and examined this application and know Ihe same to be tnie and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied with whelher specified herein or noL The granting ot a permil does not presume <br /> lo give authority to vidate or cancel the provision of any other state or Incal law regulating construc;ion or the peAormance of <br /> constructian. Tlia� I am a thorized by the owner of this property to perform the work for wliich application is made and i r,ompiy with the <br /> State C�tractors Law 1 27 RCW and 296200 WAC. <br /> ` 1 i <br /> Lc �',,°%� �;, '�-a-/o <br /> 5' na of Ow er(�onlractor Authorized Agent Dale � / <br /> Z <br />