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l <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT 5ERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810–FAX 425-257-8857–www.everettwa.org <br /> APPLICATIONS ARF ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCE�TAX I.D.ll PERMIT p <br /> �i'1211� ���.(vs.v-�,, oe 4�?� z-5 0�o p I �P� � 3 3 <br /> LEGAL LOT N0. ' BLOCK TRACT <br /> DESC. ��� � 4 . <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �Lt1fK?� �A'd{�� CC�+� ���— Z�I�I �v�Iu-�;[U�— {.—K�C�� `{�f�S"71L '?,21L <br /> TENANT NAME CONTACT FOR PERMIT , PHONE <br /> 41-c..�-�--�-u- -��.�.n I �� k G�� -r�� ���,��,��1 s ��, �� �s>>o <br /> CONTRACTOR /�p1 DDRES¢ � CINIZIP PHONE <br /> •�n � '�I � � ti V���i <br /> CONTR.LICENSE R � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> n1L+(l7�'" ��`"��'' 6 �_Electric _Gas_Other �� S�S� Oo� <br /> WORK DESCRIPTION ' / /J � ' '_ <br /> �_--� �/1� S S 1� .l.P.cJ/-'PLc� <br />' r G— ( <br /> � :`.+ �> <br /> _–)��- � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIxTURE OR ITEM <br /> Toilet AIC—air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Rt�nge hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> 3ackflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 2105 <br /> I hereby ceritify that I have read and ezamined Ihis application and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces governing lhis type of work will be complied with whether specified herein or not.The e�anting of a permit does not presume <br />� to give aulhority lo violate or cancel lhe provision of any olher state or local law regulating construdion or the performance of <br /> conslruction.Thal 1 am authorized by lhe o�vner of lhis property lo per!orm Ihe work for which application is made and I comply with the <br /> State�ontractqrs Law 1827 RCW and 296.200 WAC. <br /> , ,, z . ry �� <br /> �y,.. �� <br /> Signa7ore of OwnedContractodAuthonzed Agent Date <br /> i ��� <br />