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j.. . <br /> �ERMIT APPUCATIVN <br /> CITY OF EVERE�T PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org n' <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM fI 3I"Ob <br /> SITE ADDRE:iS PARCEL TAX I.D.# P RMIT# <br /> a — ��U�-02�( <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRE55 CITYIZIP PHONE <br /> ����'� s ����� �,� � a�6 a �l� avys� ��E����s. ��y �e�o�v <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ��1�.� l "S�.f��7 /�/� ��� �UCl�Y— E•MAIL 20C„C��Z'�5�� <br /> CONTRACTOR N� �2��' . ADDRESS CITY2IP PHONE <br /> Pruwtl��„5 /�sr� y�f�e�/a,� �vEro ��Ca�.eu�� 9�/33 <br /> CONTR.LICENSE t! <br /> l�l�}I iL5 P�G� 't I IJ �' <br /> USE G,'- BUILDWG HEAT SOURCE CONTRACT PRICE OF WORK <br /> � Eleclric �s_Other a,s' '� � �� <br /> Cr(.7�RYI — <br /> WORK DESCRIPTION �� L� - ,L..n .���J� It „ �^✓ ��L , <br /> �tir�� /) <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � Toilel _ AIC-air handling units <br /> Bathtub Forced air syslems <br /> � Lavalory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> � f<ilchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas renge <br /> Clothes washer Clothes dryer <br /> � Waler heater _ Range hood <br />- �_ Sink(service/bar/mopletc.) _ Exhaust fan <br /> � BackOow prevenler _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> � Floor drain _ Refrigeration <br /> � Grease trap _ Woodslove <br /> Roo(drains `� ,+ _ Other <br /> � Olher ��Dt9d .�.wGL _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerilify that I have read and examined lhis applicalion and knuw the same lo be true and correct. All provisions of laws and <br /> ordinaces goveming this lype of work wil!be complied with whether specifed herein or noL The granling oF a permit does not presume <br /> lo give authority(o violale or cancel lhe provision of any other state or tocal law regulating construction or Ihe performance of <br /> conslruclion.Tha am authorized �y Ihe owner o(Ihis property to perform lhe work(or which applicalion is made and I comply with lhe <br /> Slate .^.onlracl a�v 18.27 RCW and 296.200 WAC. <br /> i - • /- <br /> Signature iv . iConlractor/Aulhorized Agent Date <br />