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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32U0 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.# P�g MIT# <br /> os ��� ,�� <�o�/ocbabo�oo7 C;D OSZ <br /> LEGAL LOT NO. BLOCK TRACT OR SUBOIVISION fl <br /> oESC. ^ C J•E• /2d2 •d/S-O� <br /> OWNER ` ADDRESS CITY2IP PHONE <br /> G�.��a�/✓i7 I �u��1�'f J-�7L - �J, �X' CJ7� Ll�� �IC=Vb� �. (�JA 70 LSQ <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> . ..;, ; t Sr�`v�. W�Ar'��J' �2r• �'b�- 77G7 , • <br /> CONTRACTOR ADDRESS CITY2IP �� PHONE <br /> GONTR.LICENSE N ' �'Y�, ', � ,� i , <br /> Lr4i�c�..HrCSo� JL • <br /> USE OF BUILDING HEAT SOURCF. I CONTRACT PRICE OF WORK <br /> �'�` _Eloctric �Gas_Other — <br /> WORK DESCRIPTION <br /> Co,^s-r,�'u�-r��,� ar` �.�G qs SFie B/�ic t� l3/ <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIY.TURE OR ITEM <br /> _� Toilel A/C-alr handling units <br /> 1� Ba1hWb T Porcedairsystems <br /> _ Lavatory(wash basin) � Gas pipin� <br /> / Shower Waterhealor <br /> ! Kitchen sink 8 disposal � Gas firoplacu <br /> � Dishwasher � Gas range <br /> I Clolhas washer 1 Clothes dryer <br /> ,� Wator hoaler —� Ranye hood <br /> �_ Sink(service/bar/mopleta) .� Exhaust lan <br /> Backflow prevenler H�aat pump <br /> Urinal Unil heater <br /> Drinkinc�Fountain Boiler <br /> Floor drain Refrigeratlon <br /> Grease trap Woodstovo <br /> Roof drains Other <br /> Olher_ __ _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby r,oritily that I have road and examined�his application and know the samo lo'�e lrue and cortect. All provisfons of laws and <br /> ordinar.os governing lliis typo of work will be complied wilh whother specified herein or not.The granling of a permil does not presume <br /> to�ivo authonty lo violato or cancel Ihe provision of any other state or local I�w regulaling construction or lho pedormance of <br /> construclion. Thal I am authorizod by the owner o(this property to periorm Ihe work tor which applicalion Is made and I comply with lhe <br /> Slate Con�ractors Law 78.27 RCW and 29� . 00 WAC. / <br /> ��, ' �fcJ 5✓��v Z <br /> Sic�naturo of OwnedCo'ntracroqAulhonzed�.gent '�Date 1 <br /> /z. <br />