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PERMIT APPLICATI�N <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 ( `a1 �7 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT r <br /> / Z l�l 7D -�2 <br /> LEGAL LOT NO. BLOCK TRACT <br /> OESC. <br /> OWNER AODRESS CITY2IP PHONE <br /> CtJA�-/ E.�'�e-,�Piu1�J ��S �J ,P��E�.rio� ,s � s�O�a�ea� � �j�' s�l� <br /> TENANT NAME I CONTACT FOR PERMIT z�G PHONE n <br /> SC4TT�E Ero�D CDFF� � �'��r-1� �A2��,t/�? Sa9o96S� e�w�t �FNL}%S�' .� <br /> t� <br /> CONTRACTOR ADDRESS CI7Y21P PHONE J�MGSg <br /> CONTR.LICENSE# �� 1 ��N��� <br /> �,�31� �✓���ti ��� c�, �-- — <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas_Other 3Uj Q�� <br /> WORK DESCRIPTION <br /> � T..S, � f3U/G� D�t/G�, �TD/lA¢� COt/t�TE/L , ,OLU�/13/,c1C�— <br /> �n/� CD ��EE S/fDP <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FU(TI�RE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathtub orced air systems <br /> Lavatory(wash basin) 'X G s piping <br /> — .g��� � W ter heater <br /> Kitchen si &disposal _ as fireplace <br /> i Dishwash r Gas range <br /> � Clothes asher Clothes dryer <br /> � Water eater Range hood <br /> � Sink service/bar/mop/etc.) E�austfan <br /> Ba flow preventer _ ump <br /> Uri al _ Unit hea <br /> Drin Boller <br /> Floor drain Refrigeration <br /> Grease trep _ Woodstove <br /> Roof drains _ Other <br /> �, omer ' [DD ' S���K J. _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined this application and know the same to be true and cortect. All provislons of laws and <br /> ordinaces governing this type of work will be complied with whether specified hPrein or not.The granting of a permit does nof presume <br /> to give aulhority to violate or cancel the provision of any other stale or local law regulatlng construcbon or the performance of <br /> construction.That I ut orized by the owner of lhis property to perform lhe work for which application is made and 1 comply with fhe <br /> Sl te Conlraclors Law 1�:\7 RCy.V-and 296.200 WAC. <br /> / <br /> S' ature of OwnedContrdctodAuthorized Agenl Date lL, <br /> ; � � �� <br /> , , <br />