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� P�RMIT APPLILATItrN �z_< <�-0s <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 Cb�p `7$X� <br /> 425-257-8810- FAX 425-2�i-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS � �D.. ��.._JJ `. PARCEL TAX I.D.# PERM 7# <br /> G� '–/���R-i. rs n/ �/t� 065'O �'j DODO ( 02 �f � �Q7 3 <br /> LEGAL LOTNO. BLOCK TRAC1' <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONEq�ZS`� � <br /> Q�a � �T��r1 �1 93`( C-C�r� f-FfT�� 1�� . Fueee-IC' q62o3 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> lN�� �'i �lN- 4?5-2�6-644� <br /> CONTRACTOR ��� ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# P� ��� ' S�� �' 9 ? � � 3 ��4 �G � <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> 2�C- ��� -�"1 E ectric Gas Olher <br /> WORK DESCRIPTION <br /> (�' e-w�o ✓� 2�o •C� c�' l nr S�L 2� �Lo o R <br /> PLUMBING N � MECHANICAL N � <br /> NO. TYPE OF FIXTURE OR ITEM NO. IYPE OF FIXTURE OR ITEM <br /> Toilet A1C–air handling units <br /> Bathtub Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Cbthes washer Clothes dryer <br /> Laundry lray Range hood <br /> Sink(service/badmop/etc.) Exhausl(an <br /> Backflow prevenler Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Re(rige2tion <br /> Grease lrap Woodslove <br /> Roo(drains Olher _ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby cerili(y that I have read and examined this applicalion and know ihe same lo be lrue and correcL All provisions of laws and <br /> ordinaces governing lhis type of work will be complied with whether specified herein or nol.The granling o(a permit does nol presume <br /> lo give aulhorily to violate or cancel the pyr ' ion o(any olher state or local law regulating construction or the pedormance of <br /> conslruction.That I am aulhorized by��owner of ihis properly lo per(orm the work(or which application is made and I comply with the <br /> Stale Nraclors Law 18.27 RC �nd:96.200 WAC. <br /> �C� 4 7/5`/0_'� <br /> Signature of Ow erJCro ctor/Authonzed Agent Date �/3 <br /> j" —�,. <br /> � <br />