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P�RMIT APPLICATIt�N <br /> CITY OF EVERETl' PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEREl7, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —�nvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DE81T& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS � �"�'U �� PARCEL TAX I.D.# PERtdIT# <br /> � � <br /> ��-�^�TT /�-�1rL{, iv�� ' S lF `fl� ��Z � o S 305� ooc� z �� �li -�O <br /> LEGAL LOTNO. BLOCK TRACT <br /> oesc. 5 r(' f17%/� .flr� �;� SNFL% T/� U <br /> OWNER i�yj�F � ���� ����L ADDRESS ���,�,, CITY/ZIP PtIONE �; <br /> V �OS�U n�rt C�"'JJG NC��9ffTS I�U � �S/ - <br /> �%!� G-���1/'T s i�rr�;�iv�ITc��i� i�»�k�cT��� , �z� >�z>s /G-fC_ <br /> � TENANT NAME CONTACT FOR PERN.IT . PHONE <br /> L�;�/ib��,li !?�-S/h�t�l�Cf^ �J�' ��7v-1�-70�� X/o Z <br /> �'����y s��rr-�����., �;,,,�y �-���� — <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> ��-�� <br /> � CONTR.UCENSE# <br /> USE OF BUIL�ING (Jf%�IGF O� ) HEAT SOURCE CONTRACT PRICE OF WORK <br /> �'�oz�r7�. 5� <br /> Electric Gas Other . <br /> WORK DESCRIPTION ��,��ti� �/y� D���,r-C/y1(�,:�']�� I1iJ/N!�Z QC�Ld L/%�U/�, /t'��� <br /> ! <br /> �o�Ti��c��v�� ,L�c�t��:5 3 /-'�-� /��� <br /> PLUMBING MECHANICAL �� <br /> NO. TYPE OF FIXTURE OR IiEM �/��� NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> PathtuU Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitrhen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> I _ Sink(service/badmopletc.) Exhaust fan <br /> j _ Backtlow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceritify that I have read and examined this applicalion and know ihe same to be true and correct. All provisions cf laws and <br /> � ordinaces goveminc� this rype of work will be complied with whether specified herein or not The granting of a permit does not presume <br /> to give authority to violate or cancel th�provision of any other state or local Ia�N regulating consWciion or the per(ormance of <br /> constuclion. That I am authorize by the owner of this property to perform the work for which applic2tion is made and I camply with lhe <br /> State Contractors Laa�18. �7 RC�� d 296.200 WAC. <br /> � �✓� ' ��l � /�'�� , �; ' <br /> Signature of OwnedContra o /Auth ' d Age t � Date I <br /> � <br /> � <br />