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PLr2MIT APPLICATIO�i� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org 7 <br /> � uJ �7 - bo/ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS �7 � � �:�Cj JJa I�D A✓ PARCEL TN(I.D.# PERMIT# <br /> � Ji I,✓ Ov 5'i — o t3 —oo'� -00 � �'-� � GL7 <br /> LEGA LOT NO. � I A� BLOCK TRACT <br /> DESC. o�= >+:r 7 � A�r.s ` <br /> � <br /> OWNER ADDRESS CI 21P PH NE <br /> ZoLL� �.! l.iA�t_So � i1o'7 GDyEMo2�- �N � E✓T� �iaS- `�3B'8�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> I V�EIZfLLP M�9ET11J ya� 3y� -Loog <br /> CONTRACTOR ADDRESS CIlY21P PHONE a12�—,3[/(r/vcY� <br /> 1��qh� Tou�N I�o��Es �-�� 9aa5" 35?N A✓�c5� E✓r, 9sao8 <br /> CONTR.LICENSE p M �g�+�- y� q77 ip u <br /> USE OF BUILDING �� � R.r HEAT SOURCE CONTRACT PRICE OF WORK <br /> _C-lectric _Gas�Other <br /> WORK DESCRIPTION B u� LD A1�I,J C.0 sTon� F�oq�� <br /> ��'� � . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �'� Toilet I_ A/C—air handling units <br /> � Bathtub � V Forced air systems <br /> � Lavalory(wash basin) �� Gas piping <br /> _� Shower I✓ Waterhealer <br /> I Kitchen sink&disposal z ✓ Gas fireptace <br /> i Dishwasher � 1/ Gas range <br /> � Clothes washer �� Clothes dryer <br /> �_ Laundry tray /� Range hood <br /> J Sink(service/badmop/etc.) _� Exhaust fan <br /> Backflow prevenler � Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trar Woodslove <br /> Roof drains Other <br /> � Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hcreby cerili(y that I have read and examined this applicalion and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces�overning ihis lype of work will bo compliod with whelher specified herein or not.The granting of a permil does nol presume <br /> lo give aulhority to violate or cancei the provision o(any olher stale or local law regulaling consW ction or the perfortnance of <br /> conslruclion.That I am authorized by lhe owner of this property to pedorm the work for which application is made and I comply with the <br /> �alc�Contract rs Law 18.27 RCW and 296.200 WAC. <br /> � , <br /> � �:-�I- ``,�L�`-i '7- ,-�.� <br /> Signalu �o(OwnedContractor/Authorized Agent D te �/ <br /> Z <br />