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i <br /> PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES 7�+ . �� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �I�� <br /> 425-257-8810—FAX 425-257-8857—www.evereV00YpRrg <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.• PERMIT A <br /> ('jGl� �ve.� ceE^-�w�� 2.�'Jc;y2 �Uc��,:>>I[.r) Sc�-11\-0ll <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> ONMER ADDRESS CITY2IP PHONE �vU - <br /> c�� ���,�� �� �y�:� �:���-� �: ��,��.as �Q�2L� �IYY-749� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> klc,�� I���� � �3�i1 1..,�.� � 4:�t(-, 3,� <br /> CONTRACTOR ADGRESS ^ GTY/LP PHONE <br /> �1cY�.r- 5,�,� � F�LLti��9 �.��f, y�.��5ys���4 3�.- yzy-� 32S <br /> CONTR.LICENSE• A� L � �/ ''}'�,/( �yr <br /> \Y��v'U S�1`i ��� WIL�41 Y"HG.., 1 `�.h7� <br /> 1 <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> CA(� S-�sv�'�� — W— <br /> Electric _Gas_Other �L�� ' <br /> WORK DESCRIPTION <br /> �L,.S�.��'� i t..���� S� ��`� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR�TEM NO. TYPE OF FIXTURE OR 17EM <br /> ToiOt A/C—air henC�g units <br /> —athtub Forced air systems <br /> i avatory(wash basin) _ Gas piping <br /> Shower t aler heater <br /> hitchen sink C disposal _ Gas fireplece <br /> aishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> i aundry tray _ �ange hood <br /> Sink(service/barlmopletc.) _ Exhaust fan <br /> —ackfiow preventer eeat pump <br /> — r��a� �nR heater <br /> erinking Fountain _ —oiler <br /> Floor drain aefrigeretion <br /> Grease trap t oodstove <br /> o cof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS]106 <br /> I hereby ceritify that I have read and examined this application and knaw the same to be We flnd correct. All pravisions of laws and <br /> ordinaces governing this type of work will be wmplied wilh whether specified herein or not.The granting of a pertnit does not presume <br /> to give authoriry to violate or cancel the provision of any other stale or local law regulating conslruction or the perfortnence of <br /> construction.That I am authorized by the owner of lhis property to perfortn the work for which application is made and I comply with the <br /> State Contractors i aw 1B. T aCt and 296.200 t AC. <br /> ._�(� ( �_2`t'-�'7 <br /> Signa ure o ner/C tractor/ uthonze gent aate ' <br /> �Z <br />