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( l <br /> PERIVIIT APPLICATION <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 ARE ACCEPTED FROM 8 AM TO 4 PM ��� � <br /> SITE ADDRESS ��'r PARCEL TAX I.D.k PERMIT� _� <br /> C �n��T-s.-t-- on y <br /> LEGA LOT NO. BLOCK TFIACT OR SUBUIVISION R <br /> oesc. � - Lo � .2 2� EVER-E/%.SiJBi�iviS�o�l1 'O � � <br /> OWNER ADDRESS ��ry21P P(N�)S`�.S'aV�7 <br /> �A�en/ -�v�s �/.S2��r,a,J isii �tJ.ss�,�: StAi�zEc�i3 y�ins <br /> TENNITNAME I CONT �FQR PERMIT PHONE L( LC 11 �� z �`-' <br /> ` �(y1�(L�-`'�.�IGv ��`�IC,`1 �MPrrb.o��y•9�� <br /> l/m, ,r . E�NIAIL h.:i n+c . . f e�v+ <br /> ,4v�ni :N�n�� s C:vv�i2vu ran,� � S�� �J SS�S i �RIflE�o� zoc�55'S-za y <br /> CONTR.LICENSE�I <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> /� _ 2, _Electric �as /� Olher <br /> /1 ..J <br /> WORK OESCRIPTION - �j AS � C �`' <br /> �,.�N ►T i 3 ' 3L <br /> �-_---- - <br /> —r PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FDCTURE OR 1TEM <br /> • � Tollel A/C-air handling uNls <br /> ��_ Balhlub Forced air syslems <br /> � Lavalory(wash basin) � Gas piping <br /> Shower Waterhealer <br /> � Kilchan sink S disposal Z Gas flrep�ace <br /> Dishwasher Gas range <br /> � Clolhes washer / Clolhea dryer <br /> � Waler healor T Range hood <br /> Sink(service/bar/mop/etc.) � Exhaust tan <br /> Backilow prevanlor _ Hoat pump <br /> Urinal , _ Unil heater <br /> _ Drinking Fountaln Boiler <br /> _ Floor drain � Refrigeratron <br /> Greasa Imp _ Woodslove <br /> Rool dreins _ Olher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby co�liry thal I havo road and examinod ihls applicelfon and kraw lhe same lo be Wo and correcl. All provislons of laws and <br /> ordinaces governing Ihis type of work will be complied wilh whelher specified herein or not.The granling ol a pertnil does not pmsume <br /> lo give aulhorily lo violaln or cancel lhe provlsion o(eny olher slate or bcal law regulatlng canslrudbn or the peAortnance o( <br /> conslruclion.Thal I am aulhorized by the ownor of this property lo peAorm Ihe work(or which applicalion is made and i comply with Ihe <br /> Sl�nlractors La 18.27 RCW and 296200 WAC. <br /> ��l'�7- �7 I <br /> �i'�Sig a ure ol nodCoNraclor Agent Dale �I' <br /> Yi <br /> �- <br />