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FCRMIT APPLICATIUI� � �'� '��� <br /> , ;, <br /> CITY OF EVERETT PERMIT SEaVICES C° �`� � �� � / <br /> Gr:h �<_cm <br /> 3200 CEDAR STREEI", EVERE�f'f, WA y82U1 <br /> 425-257-8810- FAX 425-257-8857-www.everett�va.org � <br /> �7�Gi APPLICATIONS AR9 ACCEPTED FROM 8 AM TO 4 PM I <br /> SITE ADDRESS PARCEL TAX I.D.# P• MIT# <br /> - �7� � � <br /> :Nckic�V.kt� L�. �-1 `J-1 ?��'1L.`� �='��U C 1 i' <br /> LEGAL LOTNO. BLOCK TRACT <br /> UESC. <br /> OWNER ADDRESS CINIZIP Pf10NE , <br /> � <br /> (,��:(t'� ^rk��Yi�� Cr��tc✓, ��L 21�� �c.t:�c�ell�r ;�1Ji. ���,:;r�' �IkZ�'� NZSL�zz;��� <br /> TENANT NAME CON�ACT FOR PERMIT PHONE � <br /> I CS�Jc. �7t.✓Ma L(r � L�J Z—`>O2�:J <br /> CONTRACTOR PJDRESS CITYIZIP PNONE ' <br /> ��� �v�p� � �:cnr��_l C•.,�r-.1,ay <br /> CONTR.LICENSE# Z�iO , 'J2 �-i...:, t� As� �LJi/r t1 / qb h I �l� 7.'�"]_Ct,.c`� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �"(,�( ( _Electric �Gas_Other —7 �� ��� <br /> WORK DESCRIPTION <br /> s���r b����d«y ,�;��.� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR IiEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathlub Forced air syslems <br /> Lavatory Iwash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(scrvice/bar/mop/elc.) _ Exhausl fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF'cVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby cerilify lhat I have read and examined this applicalion and know lhe same lo be We and correcL Ail provisions of laws and <br /> ordinaces goveming lhis type of work will be complied with whether specified herein or noL The granting of a permit does not presume <br /> to give authority to violale or cancel 1he provision of any olher stale or local law regulating conslruction or the pertormance o( <br /> construclion.That I am authorized by tho owner of this property to peAorm the work for which applicalion is mado and I comply wilh the <br /> Slale onlra tors Law 18 _7 RCW and 296.200 WAC. <br /> Si lure f OwnedC ntractor/Authon�zed�Agent � � �al�� �/� <br />