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i <br /> PEkMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FR7M 8 AM TO 4 �M <br /> SITE ADDRESS PARCEL TAX I.D.# PERMI7# <br /> ��'��c 2i�t1 (�.t'.,.. �jp n �J <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CIN/ZIP PHONE <br /> G ��"�� ��Gia� S�Ca I S €�-c:2�,2��.; l,,;c�..� �V t;ctt.li i(-u - �s�5=�73 7 <br /> TENANT NAME CONiACT FOR PERMIT S' c)(��yn(LT PHONE <br /> c�fi�-� �'�,,vl� ��+ (:r��,z,�NGti � �v - uzz-���tti <br /> CONTRACTOR s' ���JN�p�rr' ADDRESS CITY2IP PHONE <br /> 31pD, c1Lz''U'd 5�' <br /> CONTR.LICENSE!! � <br /> l 5'/ s' Ii.'z-c�wc•., (�vL 'Mti v�lNGN ���-73 <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PRICE OF WORK <br /> E�eclric Gas Olher <br /> WORKDESCRIPTION V � �.�T� �a�,� 'ru }-f�W S�SrJ IN�� �� �.�.�aS <br /> -�- �.,ti� "7,1�:.t> ra., _n C•Ag,n-i� � S A.�G �1.N^ <br /> ���t�ln.c�� i..,k� l�, r,�,_> >,., -Yt� �tu�v l,l-e �s�,l�'cjti5 �� 5��. ��N � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ A/C–air handling units <br /> Balhlub Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kitchen sink 8 disposal Gas(ireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> Waler heater Range hood <br /> Sink (service/bar/mop/elc.) Exhausl tan <br /> Backflow preventer Heat pu�np <br /> Urinal Unil healer <br /> Drinking Founlain Eloile� <br /> Floor drain Re(rigeration <br /> Grease trap � Woodstove <br /> Roo(drains k Other <br /> �_ Other iSNS <br /> i�;us <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y lhat I have read and examincd this application and know lhe same lo be lrue and correcl. All provisions of laws and <br /> ordinaces goveming lhis type o(work will be complied with whether specified r�ereio or not.The grar.ting o(a permil does not presume <br /> to give aufhority to violale or cancol lhe provision of any olher slale or local law regulating cunstruction or the pedormance of <br /> construction.That I am aulhorize5l.qy the o�ner of this property to perform lhe work for which appfication is made and I comply with the <br /> Slate Contractors Law 18.27 RrSW bnd 29�00 WAC. <br /> Ir - ��:=— <br /> ` ___ �-- % <br /> SignA�uco-oYOivnedContrac(o�Authorized Agent Date <br /> +�Z <br />