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. . <br /> PERiVIIT APPLICATION <br /> CIT'� OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � 425-257-8810—FAX 425-257-8857—www.everettwa.org � b ��-3`�6 <br /> � � I ,� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM PU_J�p—E�r�? <br /> '� I c Gz <br /> SITE ADDRESS PARCEL TAX I.D.N PF,�2MI?� <br /> �,'aC2r,� �nd p0- 59 6a - 00 - oo - o I L(vU� � �3 <br /> LEGAL LOTNO. BLOCK T ACT <br /> DESC. � � � � lQ�� � � G�cl /' pil.� <br /> OWNER ADDRESS CITY2IP PHONE <br /> Fircl� R a�_ ES�a� . M61� a�'�.c� . I`�r dX �6&rf E✓err.H . w►� <br /> TENANT NAME C NTACT FOR PER�tIT PHONE <br /> -- tJqc��ne El- /�(.uR R �jas- 4y3- 4�42 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> Ca��y�� ��c I $q�3 �!hrN eJre� otheQE cJl4 qar- y�.� -9ll0 <br /> CONTR.LICENSE M � H"� <br /> H q a I L S iro Sas ��d.�.( 9 ! , , t G " �ci� > -� ,: � ��� <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WO <br /> �h F m � L —E�edric �Gas_Other �l.� 4� 9 L�S ! <br /> WORK DESCRIPTION / ,.� � <br /> Ne.v� HoaSe S3-` <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. NPE OF FI%TURE OR ITEM <br /> � Toilet /(' AIC—airhandlingunils <br /> � Bathtub (, � Forced air systems <br /> �/ Lavatory(�,rash basin) J�/� � Gas piping <br /> /� Shower ) L Water heater <br /> � Kitchen sink&dispasal � Gas fireptace � <br /> � Dishwasher � Gas range <br /> � Clolhes washer Clothes dryer <br /> Laundry ttay � Range hood <br /> _ Sink(servicelbar/mopletcJ � Exhaust fan �/�/ <br /> Backfiowpreventer _ Heatpump <br /> Urinal Unit heater <br /> _ Drinking Fountain � Boiler <br /> Floor drain -�� Refrigeration <br /> Grease irap / Woodstore <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat I have read and examined this application and know the same to be true and correct. All provisians of laws and <br /> ordinaces poveming lhis type o(work will be compiied with whelher specified herein or not.The grenling of a permit does not presume <br /> to give authonry lo violate or cancel ihe provision of any olher state or local law regulating construction or the perfortnance of <br /> construction.That I am aulharized by the owner of this propeAy to pet!�rtn the wark for which application is made and 1 comply with the <br /> State Contrectors Law 18.27 RCW and 296.20D WAC. <br /> 1 A(,��l1P ��- �{Uw 5 �� �0 6 _ l�y <br /> Signature o OwnedContractor/Authonzed Agent ate <br /> J�� .� U�� J � <br />