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, �-a 3 -0�{ <br /> I PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-vnvve.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED I <br /> i <br /> SITE ADDRESS PARCEL TA7C I.D.# PERMIT# I <br /> (ol�l � . .i; , , i <br /> LEGAL LOTNO. BLOCK TRACT <br /> �ESC, <br /> OWNER AOORESS CITY/ZIP PHONE <br /> C�►�y �i�m�.e-tte z�w c��I�y�G.�e �e�ze-H ��.�r8�:1 azs-z�3-5935 <br /> TENANTNAME CONTACTfORPERMIT PHONE <br /> �-r��t����z�� I (�t�.o� �I��.�L 4Z5-9'$! - IZZc,� , <br /> CONTRACTOR c � ADDRESS CITY2IP PNONE 4 z5 I <br /> 1�:.,.:EQ�hc�S�:e51.F�� iS� 3S b1y�M��c A�eS.�,.k.�i�cl�� S61t�� zsr-18� <br /> CONTR.LICENSE t! <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I _Eledric _Gas_Other Z �I !>2 , �j� <br /> WORK DESCRIPTION �r J <br /> ���'��v`� �/ � e��'.J ►�'l.�lt.��^�"_ Wr�a� ic o.�' TI� �JQ �C7CR-!'�C�I • <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower _ Waler nealer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range � ' <br /> _ Clothes washer Clothes dryer � I <br /> Laundry tray _ Range hood � /� Z I <br /> _ Sink(servicePoadmop/elc.) Ezhaust fan > r <br /> = Backflowpreventer Heatpump J' <br />� Urinal Unil heater � J <br /> _ Drinking Fountain 6oiler f � <br /> Floordrain � Refngeration �/ / <br /> _ Grease trap Woodstove f � �� <br /> _ Roof drains _ Other /l,h '� � ,11 <br /> � Otber � �/ �� � �^��� <br /> � <br /> � � <br /> CIiY OF EVERETT LOCAL SALES TAl(CODE IS J105 � � <br /> I hercby ceritify tha�1 have r and examined this applicali�n and know ihe same to be true and correct. All provisions of laws and <br /> ordinaces governing this t p work wdl be complied with wheiher,peafietl herein or not.7he granting of a pertnii does not presume , <br /> lo give au ority to violat o ncel the provision of any other state or�ocal law regulating construction or lhe peAormance of I <br /> nslrucli .That I am a t ed by the owner of this property ro perlorm lhe woric tor which application is made and I comply wdh ihe <br /> St te Con tors Law 1 7 �CW and 29620�WAC. <br /> �������� <br /> Signelure o OwnetlCont todAuthonzed Agenl Date — � <br /> y , <br />