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r • <br /> PERMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-88'i 0— FAX 425-257-8857—wvdw.everettwa.or,y <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �] `-aI �� <br /> SITE ADDRESS � PARCEL TAX I.D.# P��RM� <br /> .�-ia cI/�����N Wi�(� OD.fici�7oTioDd'� ov U Olv - .� <br /> LEGAL LOT NO. OLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �cis j��,9cc �N� 2 �60 7��f��ye � �7��-�'�r zs��. yd'��.o <br /> TENANT NAME CONTACT FOR PERMIT PHONE �j�g/7�e�� <br /> C���L L%� l�`�SIPJI ��3�j � I �CNVi�GC �e.- E•MAIL GL�i�l,Dal�.%�� � '�! <br /> CONTRACTOR �-t-� I ADDRESS CITYIZIP PHONE (/ <br /> v w/��� <br /> CONTR.LICENSE# <br /> USE UF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � -C'- < ( � ��p,�,�� �Eleclric V Gas_Olher �� O� C%'rTf� <br /> Fil cwi <br /> WORK DESCRIPTION <br /> �TI — ��Pi.lRuiY�✓iU� ,�P�7� J� �e'Y ��<i/yL . <br /> PLUMBING /g� ��3-v'nu MECHANICAL — t�_ t�r..{- <br /> NO. TYP[OF FIXTURE OR ITEM �/ NO. TYPE OF FIXTURE OR ITEM D/7�%1'/�t�il <br /> / <br /> Toilel _ A/C-air handling unils <br /> BaQilub _ Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas fireplaco <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Waler healer Range hood <br /> Sink(servicelbar/mop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal __ Unil heater <br /> _ Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease lrap _ Woodstove <br /> Roof drains _ Olher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read an�1 examined this applicalion and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces governing this rype of work will be complied with whelher speci(ied herein or not The granling nf a permit does nol presume <br /> to give aulhority t�violale or canr.el lhe provision o(any olher state or local law regulaling conslruclion or ihe performance of <br /> conslruction.That I am authorized by Ihe owner of this property lo perform the work(or which applicalion is made ar,d I comply with lhe <br /> Stale Contractors Law 18.27 RCW and 296.200 WAC. <br /> _ --'�%�-�----� �-� �/��/!l-6_, <br /> Signalure of Ov✓nedContract r/Aulhor¢ed Agent � Dale �I <br /> L <br />