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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-A810- :=AX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �C�(05E C✓e:Cf� �Zn�� U.�n� t'lU.2 .28G�13003oE.E.UG SO 1 ra-dc� 4 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER AOORESS CITY2IP PHONE <br /> iao �c E��,-e+-r ti�.rrc%.y aio� E�•:�a�✓�4 k��o� <br /> E�.t��d�-4 �l.�ll oSS�ce �3��1�1�'� t-�c (Yli) F Ci4-f'//O <br /> TENANT NAME ^ / CONTACT FOR PERMI� PHONE (Y�5� 77G 'J9"3j <br /> tG;r�tl.�y Cc,l� �s50cic�1NSLLC I GG.:;s�o���Pr L�9✓�i;�� nr,.�Oc.:rn.;fS�JE�•°��ynr-.-:is,��s. .o.�� <br /> E-MRIL <br /> i3��rrY Nz_,.. £il�.. �y511.a� � <br /> 7`/CO f�n:��rx.. .Qc,nd t�Ptc�ff� W.� `i5"�c'� <br /> CONTR.LICENSE# <br /> ��1�2�'�NC.C� 77GiL'� CY1S 77G s1`d 3$ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK , <br /> (�.�..�' � e __Eleciric _Gas_Other '� /� (j �,Q �� <br /> i <br /> WORKDESCRI/PTION Fc;�u'r;r�a� �t.k� �-�S�a�� C�} 0.1� �-�-IL��i � y i- I %}i� in'�rn�. l�Y� � ��v 'ni:k:�rcl <br /> �i✓�� C<..b�nB{' .�c,, ii �r� I �B� �c,�e fiSC�r<tFcS �LC. i� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> Toilet A�'C-air handling unils <br /> Balhtub Forced air syslems <br /> Lavatory(wash basin) _ Gas pipin� <br /> �- g�1OWe/ Water heater <br /> Kitchen sink 8 disposal _ Gas(ireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Waler healer Range hocd <br /> Sink(service/badmopietc.) _ Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> _ Drinking Fountain _ Boiler <br /> Floor drain Relrigeration <br /> Grease trap Woodstove <br /> Roof drains Other_ _ <br /> Other --- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I herehy cerilify iha[I have read and examined ihis application and know lhe same lo be lrue and currecL All provisions of laws and <br /> ordinaces governing this type ot work will be complied with whether specilied herein or not The granting of a permi!does not presume <br /> lo give aulhority�o violale or cancel the provision o!any other stale or local law regulating wnslruclion or the performance of <br /> consiruclion.That I am authorized by the owner of this properry(o periorm the work for which application is made and I comply with�he <br /> State Coniractors Law 18.27 RCW/and 296.200 WAC. <br /> r�cn���i l�,�u�ll /�i ,�ece.���x•� .�G2�T <br /> Signature ol nen ontractor/Aulhorized Agent Date <br /> — - ---//� — <br />