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� i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICA710NS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.p PERMIT <br /> '� 71 � �e��v�i1��=�-�,,a �C oS - GY> <br /> LEGAL LOTNU. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PMONE <br /> C�A ,�LS��i�J <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> CONTRACTOR ADDRESS CIN/ZIP PHONE <br /> /2E��in�SJ.•i /��i��ro. �-033�' �Ly�� �2uc 3/ov � yu3 �Y6 Z <br /> CONTR.LICENSE# /1� o Nt i¢�LL./ti 4T��v <br /> KC�GJ%n�� �'L7LC Z <br /> USE OF BUILDING ( — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> S/=.n Electric Gas Olher y� �S JZ3 <br /> WORK DESCRIPTION <br /> in/S;A tt h-//�C S P/��NK LC..Z� S i'�� .v��.�rl i 3 ) i•.� <br /> .v a.,��� J � /`�- <br /> PLUMBING MECHANICaL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTUR[OR ITEM <br /> Toilet A/C—air handling unils <br /> Balhtub Forced air systems <br /> Lavatory(�vash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust(an <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> — �� </'.��,.,�.��c.zt NcrJ O S <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Uial I have read and examined this applicalion and know the same to be true and correcL All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whelher specified herein or noL The granting of a permit dces not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance o( <br /> construction. That�am aulhorized by lhe owner o(ihis property to perfonn the work for which application is made and i comply with the <br /> State Contractors Law 1827 RCW n 296200 WAC. <br /> �`' 9 �//C `) l <br /> Si natu o Owner! ontracror/Authorized A ent ale / <br /> Z <br />