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PtRMIT APPLICATIC�N <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 �--'1�{� <br /> SITE ADDRESS �V 4-�Q f� PARCEL T!ll(I.D.# PERMIT# <br /> :�.�ji� E✓tr4ft �va l.�ll �'S�ol ��'C' ��2.��: � ,-� �� �, � � t� c; ,j Z- /f <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE y �.y',�S L4_ .�C�r <br /> . ,� '-` �.v�;`G � i— T .UD��c.'�.S..q�: ��Icj <br /> �,��lG L-����r2-�Y-' �*T�v ,s'rVE�: i li -pA`� �}Ci'c.�; j� 5i G�iN��cH , C-vE��i i,��( , GJ� ����.2 / <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> I FDD7 5 �6�:_ANC� �f�.1d�- jl�- 1S �� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> � <br /> CONTR.LICENSE# %� �//(�/JA �� <br /> L,; 'W �/C/L/ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> L t� �i ��Ct� Eleclric Gas Olher <br /> WORK DESCRIPTION <br /> - C. t4 �i !2C l-l- S' � � ti = <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathlub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower W aler heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> Waler healer Range hood <br /> Sink(servicelbar/mop/etc.) Exhausl fan <br /> Back(low prevenler Heat pump <br /> Urinal Unil hr,aler <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y that I have read and examined this applicalion and know the same to be lrue and correcl. All provisions of laws and <br /> ordinaces goveming this lype of work will be complied with whelher speci(ied herein or noL The granling of a permit does nol presume <br /> lo give aulhority to violate or cancel lhe provision of any other slale or local law regulaling consWction or lhe performance of <br /> construction.Thal I am authorized by the owner of lhis property to perform the work for which application is made and I compiy with lhe <br /> Stale Contractors Law 18.27 RCW and 296.200 WAC. <br /> Signature o(OwnedContractodAuthonzed Ac�ent Date �( L <br /> — -- I <br />