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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CFDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-- FAX 425-257-8857-wvuw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM r _ � �—O � <br /> SITE ADDRESS PARCEL TAX I.D.# PER IT# <br /> O p/ 9� S..'T /OG i�J- - <br /> LEGA LOT NO. BL6CK TRACT OR SUBDIVISION# — <br /> DESC. <br /> OWNER ADGRESS CITY2IP��r�HQ�E,t �o� <br /> . a, � <br /> _L� c.,:� P��,pEnt,�s � ,t � Ga?Dn�D� �•,� D/�d <�t t/...� 9/.?a3 <br /> TENANT NAA7E CONTACT FOk PERMIT PHONE <br /> �e w i%1 E �,c SS f/.y�v/rI'7E/Z Xh/J d��2 o?O�a�s llJ'9 <br /> CONTRACTOR F��� �,�y ,��iG ADDRESS CITY2IP PHONE <br /> � ��a y �9T�.Sl S� ao<a 9s��ss <br /> CONTR.LICENSE# F�� �o e�: 9.���D u�,�J�/�'/rl".l'- ��� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PR�CE OF WORK <br /> � Efectric X Gas OGier I � T •/���� <br /> ll6Tia.� — — <br /> WORK DESCRIPTION 3•�f�s ,�,�c-s/� <br /> fo �r'�'? mv6/L <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF F�XTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.} _ Exhaust han <br /> BackFlow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Retrigerelion <br /> Grease trap _ Woodslove <br /> Roof drains Other _ <br /> _ Olher_ <br /> — —I — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have rea�and examined lhis application and know the same to be true and correct. All provisions of laws and <br /> ordinace�goveming this type of work wilt be complied with whether specified herein or noL The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other slate or local law regulating construction or the performance of <br /> construclion.That I am authorized by the owner of this property tn periorm the work(or which applicatlon is made and I comply with ihe <br /> State Contraclors Law 18.27 RC and 29c,200 WAC. <br /> p� - � �.S-!�-L�7 , .� <br /> Signatu wned onlraclodHulhorized Agent Date \ <br /> i <br /> � 2 <br />