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i ;- <br /> P�tRMIT APPLICATIUN <br /> �I CITY OF EVERETT RFRMIT SERVICES <br /> 3200 CEDAR STHEET, EVERETT, WA 98201 <br /> 425257-8810-FAX 425257-8857-www.everettwa.org <br /> � APPLICATIONS ARE ACCEPTED FROM 0 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> I <br /> I SITE ADDRESS PARCEL TAX I.D.G PERMIT# <br /> :3�) (�c,�(-�3� /�d� � Kc�5o5-a[c� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER pDDRESS CITYI7JP PHONE�+�(y�)cjnp_g'S'.f'p <br /> M �'1-R' l�l�iNGS I�C, P�O. `�ri 112Z1 ULY�"�Pl�k� w/� y"rl-�8 <br /> ' TENANTNAME CONTACTFORPERMIT PHONE <br /> �ifl'1� AV�rr��2's o�-�ic� JL5l�✓Pc SIM �Y� Zj(vu-7_5(o-Z�ICv <br /> COMTRACTOR ADDRESS GTY/ZIP PHONE <br /> (-� Y��Zv i F� N �F�P-� r�(�Trs�i�c.n1 Q o.-�iax ��' 13 '1-'v;N PlZiil(L�E� 3�o -ZS�o -2f�l�o <br /> � CONTR.LICENSE N ��//{ �J�GO<� <br /> V,DPvs 2Z� LZ <br /> USE OF BUILDING I I HEAT SOURCE CON7RACT PRICE OF WORK <br /> I _Electnc _Gas_Olher `���U� �—� <br /> T-. <br /> iWORK DESCRIP710N <br /> �{-(70 N`cW �Cl`�i' �'jf'(ZIN,�Lt7'L !-I(7}�� '� '9C�OMc+.D/�7�, NC�l� <br /> -r�n,a�v-r. CMuDrr=Y FJ«S�i�:,e� i,.��T SPrz��.+kt�rc_. Sysrcw�� <br /> �i PLUM8ING MECHANICAL � <br /> I NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet A/C–air handling unAs <br /> 8athtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> _ Shower Waler heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Ciothes dryer , <br /> Laundry tray Range hc�od <br /> Sink(service/bar/mop/etc.) Ezhaust tan <br /> BackOow preventer Heat pump <br /> Urinal Unrt heater <br /> __ Dnnking Fountain Boiler <br /> _ Fioordrain Re6igeralion � <br /> _ Grease hap Woodstove � <br /> Roof drins Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS�106 <br /> II hereby centify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this typr.of work will be complied wRh whether spedfied herein or nol The granling of a pemiit does not presume <br /> to give aulhonty to violale or cancel the prwision oi any other state or local law regulating construction or the performance of <br /> construction. That I am authonzed by the owner of this property to perfortn the work for which application is made and I comply with the � <br /> � State Cont�ctors L w �27 RCW and'e96.200 WAC. <br /> � �f^ � ��---- 5 -i/-�� <br /> I /jgnaturr of rnar/Contractor/Aulhor¢etl Agent Date � <br /> / <br />