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; <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 96201 <br /> 425-257-8810—FAX 425-257-8857—www•evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE\ADDRESS \ <br /> PARCEL TAX I.D.p PERMIT N <br /> � n l �.✓1 L� �1 T �J� �Ol�ll-G7�� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CIN21P PHONE <br /> �av���, _e.; ���t�� iC d� Cn�,l�,vti� Avo �,�.� � �Iz3.3�� 1�`.� <br /> _— I CONTACT FOR PER611T PHONE <br /> TENANTNAME <br /> , 2k �a k ��ZS� S� . � �,�o <br /> CONTRACTOR 1,p � �F �ADDRESS I(c����y��I6� Sf, C1TY21P PHONE <br /> �/z�5��k; ��'j,1�K. K�rkiln�( C-/ZS• �7�, l�ti <br /> CONTR.LICENSEN �/�U SL/ <br /> nUSE OF BUILOING HEAT SOURCE CONTRACT PR�CE OF WORK <br /> / ��\ � Electric Gas_Other e7 V�-r1 � , n�, <br /> �'S1 L�,...r1��C C <br /> WORKDESCRIPTION "�Q !1 . � 11 �� w`�r� �N�(yY*���i-ZN�, ��'l\yl� <br /> K KO 'tt� t"" . <br /> I IE� �V�\Vlc�� l0 �J��� � <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR�TEM <br /> Toilet _ NC-airhandlingunits <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water healer <br /> Kitchen sink 8 disposal _ Gas freplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/barlmop/etc.) _ Exhaust tan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain _ Boiler <br /> Ftoor drain _ Refngeralion <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby centity that I have read and examined this application and know the same to be true and cortecL All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether speci5ed herein or not.The granting of a permit does not presume <br /> to give aulhority to violate or cancel the provision of any other state or local law regulating wnstruction or the periormance of <br /> construction.That I am authorized by the owner of this property ro pedorm the work for which applicalion is made and I comply vnth the <br /> State ontractors Law 18.27 R W nd 296.200 WAC. <br /> �� , . � A , � �� , 2.2 •��%� <br /> Signature o Owned ont r/Authorized Agent Date <br />