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F�RMIT APPLIC�1TIvN <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�iRE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARUS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.w PERMIT p <br /> � � , I��r�.1 - " .�54 ' �ll0 -:��`I C� I Basa�-c��9' <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRE33 CITV2IP PHONE <br /> I' .��L.-�LI 5,�,�t,Ar� 1 Ic� ► v- � 9� <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> � M s o� r <br /> CONTRACTOR S��nr 13�,IC�i n�S LIIC ADDRE33 a7pp (/l� l�✓F ITY21P$ [yrx HONE 3(LD(�d.�j 113y <br /> 'jFSYj 1 <br /> CONTR.LICENSEk � �� r Q ` � 9 � �—a Gq/�-� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> PP"��' �f L1 M E LTi'a/AC F /YL E�e ��Gas�Other I /���� o 0 <br /> ! <br /> WORK DESCRIPTION <br /> � o X � �? <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TVPE OF FI%IURE OR ITEM <br /> _ Toilel � A/C—air handling unils <br /> _ Bathlub �-'� _ Fmced air systams <br /> __ Lavatory(wash basin) � � Gas pipinc� <br /> _ Shower Water hoater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gasrange <br /> _ ClMhes washer Clolhes dryor <br /> _ Laundry tray / Range hood <br /> _ Sink(snrvice/bar/mop/etc.) Exhausl lan <br /> � Backllow prevonter � Hea! um <br /> P P <br /> Urinal Unit healer <br /> _ Drinking Fountain/ Boller <br /> _ Floordrain � Relrigerallon <br /> _ Greaso trap Woodslove <br /> Roof drains Olher <br /> Other — <br /> CIN OF EVERETf LOCAL SALES TAX CODE IS J105 <br /> I horeby cerilily lhat I have road and examinod this application and know the sama to be tnie and wrrect. All provislons of laws and <br /> ordinaces governing this type ol work will be cc mplied wilh whether specilied herefn or nol.Tho granfing of a permll does not presume <br /> lo givo authority lo violalo or cancol the provislon of any other slate or local law regulating construclion or the performance of <br /> conslruction.That I am authorized by the owner of lhis pmpeAy to periorm the vrork for which application Is made and I comply with the <br /> Stato Coniraclors Law 1827 RCW and 2�J6.200 WAC. <br /> l� / �,.� � � <br /> n <br /> (�"� �l7 L�CI)'O 7�� � <br /> Signalure o wne oTactor/Aul onzed Agont e ` <br />