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PERMIT APPLICATiUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT', WA 98201 <br /> 425-257-8810 - FAX 425-257-6857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROfd 8 AM TO 4 PM <br /> SITE ADDRESS PARCC-L TAl(I.D.# PERMIT# ,r <br /> .3�Z (, �Avatlw�� Si� 3D � Cj/OG�O SvODUpt OU ��7C�7-0(/`I <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �,�,.�u� 3�1L1� �3�iom�iw,��, f�t��i 4�Lo6 - til .rsi3i? bJ <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �,a-��i Ti t�z�� �.J•�-,�� �.� 3�0_ �5�- �SaS <br /> CONTRACTOR ADDRESS CITYfZIP PHONE <br /> i� cr-1 sylLz�J�1-��� c.yL 1711 ��u,L � t�t. 3�i.i1�,�51z.N �jvia� - 3�o757G �/ <br /> CONTR.LICENSE# �LN�M� L I � �/, ILC. <br /> USE QF BUILDING 1 HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Eleclric _Gas_Other ,3S O d _ iJ D <br /> WORK DESCRIPTIOh <br /> I / <br /> 1U.� (o �/- i i�i Y�/t�r �-a-, `9,,., 5 ,- �t � t, � lc,, ,c � � <br /> PLUMBING ' MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet A/C-air handling units <br /> �3a!htub Forced air systems <br /> � Levalory(wash bacin) _ Gas piping <br /> Sh�wer Water healer <br /> Kilc�ien sink&disposal _ Gas fireplace <br /> Dish4�asher Gas range <br /> Clothe.:washer Clothes dryer <br /> Laundry Iray _ Ranga hood <br /> � Sink (sercice/bar/mop/elc.) _ Exhaest fan <br /> Backflo�v preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVEREI7 LOCAL SALFS TAX CODE IS 9105 <br /> I hereby cerilify th�t I have read and examined lhis applicetion and know the same to be true and correcl. All provisions of laws and <br /> ord'naces govem�n�this rype of work will he complied wiih whether specified herein or noL The granting o(a permit does nol presume <br /> lo givo aulhorily lo violate or cance�the provision of any other state or local law regulating construction or the p�dormance of <br /> r,onslruction.That I am authorized by the owner o(Ihis property to perform Ihe work(or which applicat'on is made and I comply with lhe <br /> Slate Cop actors Law 18.27 RCW and 296.2C0 WAC. <br /> � __ �—/D—O-] <br /> Signature of OwnedConlractor.�Authorized Agent Dale <br />