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PE�2MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM Tn 4 PM '� .r 1 S —D.p <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 3 C� %(�O(�' - ? <br /> , , <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ti��� �r- IJr�ii,l�i� /� �/�S�ZL.�I� �n�f5'', i7Y,,..o�i�cl �tC .�l�t"iifJ7� �/�v-353-F�3Sr <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �';�� inr �t�'�-.�z�n��G>r�5 �� �✓r�l so.� �/�� � 3115 • g �33 <br /> CONTRACTOR AODRESS CITY2IP PHONE <br /> CONTR.LICENSE p <br /> �R�'rSR� o�/iKs /�'/�'i ��'�'��.�! .�1 �� �`l'aa�nr,.nmlf lti//� <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �, r n T�Eleclric _Gas_Other �iQ CL-� � <br /> �1 <br /> WORK DESCRIPTION � ' <br /> / �F��,a�G�/ , /t�w ��.i]�jz� wc'ty , l'�tc_ lYL�Gt�i75� � {?Z'�f �frcrirt/nf. <br /> K�-!� �c�-- <br /> W/F'Y�1��6 � l �� S� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �_ Toilet _ A/C—air handling units <br /> / Balhtub Forced air syslems <br /> L_ Lavalory(wash basin) � _ Gas piping <br /> �_ Shower ',^l! _ Waler heater <br /> � Kitchen sink 8 disposal _ Gas firepiace <br /> � Dishwaslier _ Gas range ,i <br /> Clolhes washer _ Ciothes dryer / <br /> Waler healer �_ Rangr hood `'� <br /> Sink(servicelbadmop/etc.j � Exhaust fan <br /> Backflow prevenler _ Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap _ Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerility that I have read and examined Ihis application and know the same to be lrue and correcL All pmvisions of laws and <br /> ordinaces governing this rype ot work will be complied with whelher specified herein or nol.The�granling of a perm�t does oot presume <br /> to givo aulhority lo violale or cancel tho provision of any other slale or local la�v regulaling consWction or the performance of <br /> construction.That I am authorized by Ihe owner o(this property to per(orm the work for which application is made and I comply with the <br /> Slate Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> J / / <br /> /L�n i l i��-n� GL/'�/GG _ <br /> 5i naWre oF O ner/ContracrodAuthonzed Agent � / <br /> l � <br />