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PC, :MIT APPLICATIO�� <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 FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS �"'t-���SCc�"'. ""'' ppRCEL TAX I.D.# PERMIT# <br /> � c.,SC.b -� lC , <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER �'��,� N'I ADDRESS CITY2IP PHONE <br /> P-es-.��C�,��e ,(�c��s�v� IoS�� Nwy99 Sa�,f�. .�t/-c1'�<�- �1a5=3�1�-s7G3 <br /> TENANTNAME CONTACTFOR ERMIT PHONE <br /> �'�es��c�u�� N�'���, (��,I c�,�� � 36�� y2k-i3zs— <br /> CONTRAC OR p AUORESS CITYIZIP PHONE <br /> �cY.tS�it����cCu.�.(��'S� �E�f-��++y�1�I �'�'��. �GU.tiI Ut.f�1u`n �' f� <br /> CONTR.LICENSE# � � p l���2 C�� l—�3 2S <br /> l0 ] <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> / �v�,U"�- <br /> �� `� V � ElecMc Gas Other � <br /> WORK DESCRIPTION <br /> t�5�� I P�(�c S ��c� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR�TEM <br /> Toilet A/C•-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(viash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range haod <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer H�at pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeretion <br /> Grease trap Woodstove <br /> _ Roof drains Other <br /> � _ Other <br /> i <br /> � <br /> ' CITY OF EVERE7T LOCAL SALES SAJ(CODE IS 3105 <br /> I hereby ceritify that I have read and examined this aoplication and know the same to be true and correct. All provisions of laws and <br /> I ordinaces governing this type of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give authonry to violate or cancel the provision of any other state or local law regulaGng construction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> � State Contractors Law 1 B 7 RCW and 296.2U0 WAC. <br /> I� ��•� �_ �_� �I/ <br /> Signature of Owner onlractonAuthonzed Agent Date �/y <br />