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PE,IMIT A,PPLICATIO�� <br /> CITY OF FVERETT PERMIT SERVICES <br /> 3200 CEDAR STF?EET, EVERETT, WA 98201 <br /> �125-:?57-8810— FAX 425-257-8857—www.everethva.org <br /> APPLI�ATIONS ARE ACCEPTED FROM 8 AM TQ 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRES3 PARCEL TAX I.D.# P RMIT# <br /> �I`3o9 �leR� � �.vea�1-1- oo v/o - ac ; o 'C23�` , <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONEa53- E59-3e�0 <br /> A� � ' �c (�.�r,��. �iLo�PaZCleS ii�c d.�Oa.39 �D��''AreS4� ke�� �JA .9��)30 <br /> TENANT NAh9E CONTACT FOR PERMIT PHONE <br /> m�m� m�a�, N����+QN �� ����� � ��I�u c�s}��v A �� � 5�0 -i9o3 <br /> I CONTRACTOR KO`oR K`�ChcNe�Ath AODR SS �D3b UQXt�R AVQPI��TY2�R PHONE <br /> �•241 52a'c��e �A ao�- �so -�qo3 <br /> CONTR.LICENSE# I�U\Of�kg�4�N3 ����� <br /> USE OF BUlLDIN� HEAT SOURCE CONTRACT PRICE OF WORK <br /> �.s�a���� I _ � _ I �5 0 0 0 °� <br /> Electnc Gas Other <br /> WORKDESCRIPTION L,9h� �r�MSL� �IZ\I�/��� L.�qh�' ��2C�1CA�_ 5�1�J CO�RAC�tiq� <br /> ��.��-�ht P1vr��o�cs� '�ul�CQN�RAC�QQ� �A 1 IJ�� C��AN U{� � -f't I e, `i'R�r� <br /> PLUMBING MECHANICAL <br /> NO. TYPE UF FIXTURE OR ITEM NQ. TYPE OF FIXTURE OP.ITEM ' <br /> Toilet A/C—air handling units ' <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower INater heater <br /> Kitchen sink& disposal Gas fireplace <br /> Oishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hcod <br /> Sir,k(service/badmopletc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floo;drain Refrigeration <br /> Grease irap Woodstove <br /> Roof drains Other <br /> .I <br /> Other <br /> : I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> II hereby ceritify that I have read and examined this zpplicaGon and know the same lo be true and correct. All provisions of laws and <br /> ordin�r.,��-�;ou�rg this type of work will be complied with whether specified herein or not.The granting of a oermit does not presume <br /> i to�ve authonty to vibf e or�ancel lhe provision of any other state or local law regulating constructicn or lhe performance of <br /> Ico struction.That I am au ized by the owner�f this property to perform the work for v�hich zpplication is made and I compty with the <br /> Sta C ractors Law 18.27 R ' and 296.200 WAC. � <br /> i . �- 3 ,v <br /> I Signature of 0 ontractor utho � d Agent Date �L <br /> I <br />