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PERMIT APPLICATION <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 PARCEL TAX I.D.tl � PERMIT p � <br /> � 1 z 6 � �1� ���t " �� <br /> LEGA LOT NO. E3LOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE � <br /> �'tivr -�- >�0 3I26 v'u.��, • , � � :!e 30\ �.r•� � ie �`5� \ <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> �� t"�C��� i . �^ l.`��' �s,c.�'� \'�� 'R\ / C�C." % 1 � ' ���{ I _ <br /> CONTRACTOR �S \:��1�' ( v f�S��- ADDRESS 7 gyHS -`3�,\ CIiYlZIP PHONE <br /> (-1� S.� b�<.ck l7�ai�y�Jy %`GL1G <br /> CONTR.LICENSE# <br /> Z C=�, -i'S'3 �7. 7 <br /> USE OF BUILDING NEAT SOURCE I CONTRACT PRICE OF WORK <br /> !� � ,� � � �Eleclric _Gas_Olher M S �` O <br /> WORK DESCRIPTION <br /> �1�_C� l�%6�� �lC�^^ E�ni7���� �U�C l.�v���� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet NC-air handling unils <br /> Balhtub i _ Forced air ayslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal Gas fireplaco <br /> Dishwasher Gas range <br /> Cbthos wasY,^r Clothes dryer <br /> Water heater Rango hood <br /> Sink(serviceNar/mop/etc.) Exnausl fan <br /> Backflow provenler Heal pump <br /> Unnal Unil healer <br /> I _ Drinking Fountain = �oiler � <br /> Floor draln Refrigeretion <br /> Grease trep _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF[VERETT LOCAL SALES TAX CODE IS 3105 <br /> I horeby coritify lhat I havo read and examined this applicalion and hnow lhe saine to bo true and correct. All provisions of laws and <br /> ordinaces goveming lhis typo o(work will bo complied with whether specified heiein or noL The granting of a permit does not presumo <br /> to give aulhority lo violate or cancel lho provision of any other state or local law regulating con�truction or lhe performance of <br /> construclion.That I am authorized by tho owner of this property to pedorm the woik for which applicalion is made and I comply wilh the <br /> State Conlractors Law 1827 RCW and 29fi.200 WAC. <br /> 1 „��� ���_-�c- `�� � I�b�-7 <br /> Rignature of OwnodConlracror ulhonzed Agent D3te <br />