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PEkMIT APF'LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-�857-www.everettwa.org <br /> , c APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM g �� �` � C) <br /> ( <br /> SITE ADDRESS PARCEL TAX 1.6.# PE?RMIT# <br /> . - — a ` 9 f�� . - � �"� ./'I�I <br /> LEGAL LOT NO. � BLOCK TRACT OR SU801VISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP � PHONE <br /> ►.�., ��1 c 1-,�� �o �,- �?9 - g���, a <br /> TENANT NAME p�-�nvr CONTACT FOR PERMff PHONE 11�.�bO '�j.�rG�G' <br /> �+ ' —j-�/m�rr�y ' m � � E•MAIL C��h6duncor5�t��} � <br /> � wv� ) J�'1 � d(� � _S�" I <br /> COFTRACTOR ADDRESS CITY2IP PHONE ' M <br /> CONTR.LICENSE# , � <br /> '�4�r7� �✓� ��� '�r/0.� �Ul�✓1 QCJYi�� <br /> USE OF BUILDING HEA'f SOURCE C/ON�TRACT PRICE OF WORK <br /> �nllfooml�Rn�-' SL�10o1 _Eleciric __Gas_Other �"��� <br /> WORKDESCRIPTION 2d �ivl� W���Si OO/110 � cJ��� �I1ci�t ! 11vi��vt�QN'16✓7 ( <br /> FJ <br /> Vlo I��,�h�h � me��a.,;cc� wor (� <br /> PLUMBING , MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathlub Forc?d air syslems <br /> Lavatory (wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Cblhes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mop/elc.) _ Exhausl fan <br /> Backflow prevenler __ Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeralion <br /> Grease lrap _ Woodslove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y lhat I have read and examined this application and know lhe same to be true and correcL All provisions of laws and <br /> ordinaces goveming lhis lype of work will be complied wilh whether specified herein or nol.The granling of a permil does not presume <br /> to give aulhority lo violate or cancel lhe provision of any other stale oi local law regulaling conslruction or the performance of <br /> conslruclion.That I am aulhorized by lhe owner of this property lo,>erform lhe work for which applicalion is made and I comply wilh lhe <br /> Slale Conlractors Law 18.27 RCW and 29G200 WAC. <br /> � �1 l" �'-<,?6-�— <br /> S'c�rtalu �t- wnedCo uthorized/�yent Dale <br /> � r <br /> �' <br />