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l • ' --� <br /> PERMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES n�_o <br /> 3200 CEDAR STREET, EVERETT, WA 98201 6 ` � <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM ��,J �U.� ' -?-� <br /> SITE AGORESS PARCEL TAX I.D.# /�PERMIT# � <br /> � 0i �✓tr: Yk¢n ��'ul �v_vu�l rJ Di�� - C��l�> <br /> LEGAL LOTNO. BLOCK TRACT / <br /> DESC. '--""-� <br /> OWNER y��' ST� AVF S ,rG1c� nLu6U+a ADORESS CITY2IP PHONE <br /> � � N2—W 13�I�.A��'%NL3 T�� C���S ��/9;u l� fl-'�/ ����- C—UL-}:C7YQCn N�rrv��Ve'�f t' <br /> TENANT NAME CONiACT FOR PERMIT PHONE <br /> D�-lv= 1� K ;,M Say� ,c ;,w, �i�>fi) (ri z —3✓'d'I, <br /> CONTRACTOR /1 1f � ��(� AODRESS CITY2IP PHONE <br /> �� r� <br /> CONTR.LICENSE @ P 1� C /lU(� �f� �y.V ��d'"3 Nwy 99 QJE� L�:uA/tw�e � 4y�'� �Lf>�')69y—.��y <br /> Q,�3� <br /> USE UF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> f`l�%�Z;.�_-/ _Eleclric _Gas_Olher � -�;;;��c� <br /> � <br /> WORK DESCRIPTION ,, ,/ �� � „ ) .. `\ <br /> C I'r��%u��,niY-tz�� /�� bSG � 00� � <br /> iJuw �3ul.�D�Nf� � <br /> PLUMBING MECHANI�AL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> 8athtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer l;lolhes dryer <br /> Water heater Range hood <br />� Sink(servlce/baAmop/elc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain � Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodslove <br /> Roo(drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TPJ(CODE IS 3105 <br /> 1 hereby cerilify lhal I have rad and examined this applicalion and know lhe same to bo true and correcl. All provisions of laws and <br /> ordinaces goveminc�thls typo of work will ba complied with whether specified herein or noL The granting of a permil does nol presume <br /> to give authority to violale or cancel the provision of any other state or Iocal law regulating construction or the pedormance of <br /> construction.That I am auti�orizetl by lhe owner of lhis property to per(orm the work for�vhich applicalion is made and I wmply with lna <br /> Slate Contractors Law 18.27 RCW and 296.200 y�AC. <br /> � ��.,�% 3� ,,�� �, �� <br /> �i ; <br /> Signature of Owner ontractor/Aulhorized Agent Date ' �, <br /> l, '/ <br />