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PE.IMI�' AF'PLICATIO�v <br /> CITY OF EVERETT PERMlT SERVICES <br /> 32Q0 CEDAR STREET, E��ERE iT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everethva.org <br /> APPLICATIONS ARE ACCEPTcD FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITEADDRESS �' '� � PARCELTAXI.D.# PERMIT# SO�IOQ-0(� <br /> i � � �1�('ti7 (�v� � v�f:L=(I pCisl lS� �Oot�Pa '- v <br /> LEGA LOTNO. BLOCK TRACT <br /> PESC. <br /> 04VNER AOURESS CITY/ZIp PHONE —' <br /> \��ll� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> I ,���-���D �c�NE� I �'�'I�KC �.'OI C � � �-7.��c-��� � y <br /> /�.. <br /> CONTRACTOR ������ ,� ������ ���F ���qD�RESS „� r,�7y21P PHONE <br /> ,�:ZIr� lOCrk �I 5t� .: � ,, <br /> CONTR.LICENSE# �.VL��1�� t-1 �'� <br /> Mt��c���v� c��,>�� �r��2��> �������.�-�-1 <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � �� <br /> ;1�`-Z, <br /> Electnc Gas Olher <br /> WORK DESCRIPTION 1 -- ��i L�`;f L� j ON �/.�- Lv��I— �— I�UC� n(�n` <br /> f,�=;�,��-� -��� T C,�> , <br /> �t ��N rl� Cr�''�k t'`��i� �rU D��c�� <br /> ; <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO, TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—airhandling units <br /> _ Bathtub Forcedairsystems <br /> _ Lavatory(wash basin) Gas i in <br /> Shower — P p 9 <br /> — Water heater <br /> _ Kitchen sink&disposal Gas fireplace <br /> _ Dish�.vasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/bar/mop/etc ) Exhaust fan <br /> _ BackOow proventer Heat pump <br /> Unnal Unit heater <br /> _ Dnnking Fountain Boiler <br /> _ Floordrain Re(rigeretion <br /> _ Grease irap Woodstove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS]105 <br /> I hereby ceritify that� have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of�vork will be complied with whether specified herein or�ot.The granting of a permit does not presume <br /> to give authonry to violate or cancel the provision of any other stale or local law regulating constructicn or the peAormance of <br /> construction.That I am authorized hy the owner of this property to perform the work for�vhich application is made and I comply with the <br /> ! State Contractors L2w 1817 RCW and 29620C WAC. <br /> � �'��,' � �? V .. � , <br /> , ,"f \� 7�T � i� � <br /> Signature of Owne�f��ntractor/Au onzetl Agent Date � '�L <br />