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PE�2MIT APPLICATION <br /> CITY OF EVERET i PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 58201 <br /> 425-257-8810- FAX 425-257-8857 -www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S —� ��7 <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT 1{ <br /> Si�� w . C/1J�N� /?/ Sr«,/i xl� ���._2_ <br /> � LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> cL1/ �/'.f ��� 1�2(A7(ltL(L� JCd>Qi�e� / <br /> TENANT NAh1E CONTACT FOR PERMIT PNONE <br /> �AV/� �iE�'l'i� �f�uCd ��E`'Z'�`'O �3� ' 3yc/-t�c'� <br /> CONTRACTOR • ADDRESS, CITV2IP PHONE <br /> �AC�� �Lcu/t�fi� /�. D.�j19c 5?. 7$ �1.� 253 ' � ' �53 <br /> CONTR.LICENSE N � LJ(DIe� <br /> " � i�/I�X .. <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> /-�A�� SN�[�c� ,�i Eloclric _Gas_Othar �/Doc�� <br /> WORK DESCRIPTION . <br /> ,�r�,�t o«� �/�>,5 �,ti��>n.'% ��'�'�.,,tir� , $'���/,,c'J <br /> / <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE Of FIXNRE OR ITEM <br /> Toilol A/C—alr handling units <br /> Dathtub Farcod air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Walor hoalor <br /> Kitchon sink 8 Aisposal _ Gas firoplaco <br /> Dishwasher �� Gasrengo <br /> Clo�hes washor �/ �� � _ Cblhes dryor <br /> Walorhoator � /��� G�' _ Rangohood <br /> � Sink(sorvice/bar/mop/olc.) _ Exhaust tan <br /> _ Backllow proventor ��lr�•7 _ Heal pump <br /> Urinal Unit hoalor <br /> Drinking Fountain �� y,!f. J�� Boller <br /> sS'_ Floordrain ��j if '/ 'J" _ RelrlgeraUon <br /> Groasa tra� _ Woodstove <br /> Fioof drains Other <br /> Olhor <br /> CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> I heroby cerilify thal I havo read anA ezaminr,d Ihis application and know lho same to be Irue and correcl. AII provisions of laws end <br /> ordinaces governing Ihls lype of work will be complied wilh whether specified h�arein or not.The granting o(a permlt does no�presume <br /> to givo authonly to violate or cancei the provislon of any olhor state or local law regulaling consWction or ihe peAortnance ol <br /> conslruclioa That 1 am authorized by thu ownor of this pmporty to perlorm the work for which epplication Is made and I comply wilh the <br /> Stalr,Contraclors Law 1027 RCW and 296.200 WAC. <br /> � <br /> . ;i�, �� `-t� irr 4 S �y �7- <br /> Signature o(Own dContractodAulhorized Agont Date �� <br /> y <br />