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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7. —S—C"J� <br /> SITE ADDRESS PARCEL TAX I.D.# PER IT <br /> ��� 5 c,eC�,� � R bo�/4�y� oot�o 3ono o�-�n <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> C R;�� 5��Nrw� e+-,� i��s c ��W�� � ����, yz 5 3 S'�- �S�',�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE � <br /> �G7�,; �-�^ ..-`. v�_ ,���� sy "a' - � l�s <br /> � E-MAIL <br /> CONTRACTOR ADDRESS CITYIZ P PHON <br /> i]A��./,�AxSctivcus;a�.1No��.�s ioSv,ll,P��l� � P. , �. ��r�i$2n3 �/z�ZsS`-��So <br /> CONTR.LICENSE# D �✓g�C�D/J A�,�--� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> C��R��� I _Electric _Gas_Other�� '���� DOO ^ <br /> WORK DESCRIPTION <br /> C DNS i. A F ��-'..� �►4 E.' �-G-� ' [�C/�X3-} <br /> ( 2?�� �`�°� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR Il EM <br /> Toilet A/C—air handling units <br /> Bathlub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink fservice/badmop/etc.) _ Exhausl(an <br /> Back(low prevenler _ Heal pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i hereby ceritify lhat I have read and examined lhis applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this typo o�work will be complied with whether specilied herein or noL The granting of a permit does nol presume i <br /> lo�ive aulhority to violale oi _,��el the provision of any other stale or local law regulating consWction or tne performance of <br /> conslruclion.Thal I am aulhoriz d by the owner of lhis property to perform lhe work for�vliich applicalion is made and I comply wilh the <br /> Sl �Conlracly� Law 18. 7 W and 296.200 WAC. <br /> ��GtU�LI/�z, �C:c-La-�_� /'/G -c � <br /> SignaWre o(OwnedCon ractor/Nuthorized Agent Date j/ <br /> �� <br />