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I <br /> PERMIT APPLICATION <br /> CITY OF EVERE7T PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM Tb 4 PM <br /> SITE AQDRESS �1`f�-� L-ua�rer,.+ Way PARCEL TAX I.D.# �ER��'# <br /> �u"C2Et o-✓A 9�'a� ,�(� � - OD� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER AODRESS CITY2IP PHONE <br /> ���� Kin' uY�� 2-v�.-frc�+ w"Y c�6ere�lt V�d'- ��/- 6'i3/ <br /> TENANT NAME CONTA FOR PERMIT PHONE <br /> 7��1, �L:�v� E-MAIL _ <br /> CONTRACTO �� ;� u,s,n ��./L ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE# 6�i - 9 C y'- 3 �, /5-/of Nay Sj� um:� /} �j.,�.�w.ro.,� �-�-f= 7ctr-o 96z <br /> � �—��-�Gl <br /> USE OF FiUILDING HEAT OUFCE CONTRACT PRICE OF WORK <br /> ElecUic Gas Olher � 3� �"°�� ' <br /> WORK DESCRIPTION <br /> Lv2/Lh ,iL.� �ZFFC� S1,D,h �MS..�Y..�, �n, .�.4C w0..�� . <br /> J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITFM NO. TYPE OF FIXTURE OR ITEIn <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishw-,sher Gas range <br /> Clolhes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/badmop/etc.) _ Exhaust(an <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Doi�er <br /> Floor drain Retrigeralion <br /> Grease lrap Woodslove <br /> Roo(drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhal I have read and examined this applicalion and know lhe same lo be We and correcl. All provisions of laws and <br /> ordinaces governiny lhis type of work will be complied wilh whelher specified herein or nol.The granting of a permit does nol presume <br /> lo give authority lo vio�ale or cancel Ihe provision of any other slate or local law regulating conslruclion or lhe performance of <br /> construclion. Thal I am aulhorized by ihe owner o(lhis property to pedorm lhe work for which application is made and 1 comply with lhe <br /> Stale CoNractors Law 18.27 RCW and 296200 WAC. <br /> ` !��_'�i 3- �-h"'� . <br /> Sign�Wm.of Owner/Conlractor/Aulhorized Agent Dsle 1/2 <br />